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Rutherford G, Hussain R, Tait K. Pattern of multimorbidity in middle-aged and older-aged people with mild intellectual disability in Australia. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13215. [PMID: 38413378 DOI: 10.1111/jar.13215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 11/15/2023] [Accepted: 12/12/2023] [Indexed: 02/29/2024]
Abstract
BACKGROUND Non-communicable diseases (NCDs), also known as chronic diseases, now constitute a major proportion of ill-health across most adult and older populations including in people with intellectual disability. The current paper is a comparative analysis of prevalence of NCDs across mid-aged and older-aged people with mild intellectual disability. METHOD Comparative data comes from two cross-sectional surveys using similar methodology and timeframes. The analysis sample comprises mid-aged group (30-50 years, N = 291) and older-aged group (≥60 years, N = 391). RESULTS People with mild intellectual disability start developing NCDs in early to mid-adulthood and increases with age. The mean number of NCDs in mid-aged group was 0.86 (SD, 0.84) compared to 3.82 in older group (SD, 2.67). CONCLUSION There needs to be early identification and management of NCDs using relevant health promotion and preventative measures at optimal intervention points. The training of healthcare professionals needs improvement.
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Affiliation(s)
- Grace Rutherford
- School of Medicine & Psychology, Australian National University, Canberra, Australia
| | - Rafat Hussain
- School of Medicine & Psychology, Australian National University, Canberra, Australia
| | - Kathleen Tait
- Macquarie School of Education, Macquarie University, Sydney, Australia
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Ryan J, McCallion P, McCarron M, Luus R, Burke EA. Overweight/obesity and chronic health conditions in older people with intellectual disability in Ireland. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2021; 65:1097-1109. [PMID: 34750916 DOI: 10.1111/jir.12900] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND This study examines overweight/obesity and chronic health conditions (CHCs) in older people with intellectual disability (ID). METHODS Data for this cross-sectional observational study emanated from Wave 2 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing, a longitudinal study assessing the health and well-being of older Irish adults with ID aged ≥40 years across all levels of ID. Participation involves an interview process and collation of objective health measures. In this study, body mass index (BMI) (n = 572), used as a measure of weight status, was examined with clustered doctor's diagnosed CHCs. Descriptive analysis was conducted where counts (n) and proportions (%) were used to summarise the variables univariately, while cross-tabulations were used for bivariate summary into counts and proportions. With overweight/obesity prevalence established and patterns described using logistical regression, Pearson's chi-squared test was used to test for significant associations. RESULTS Overweight/obesity identified in 69% of participants occurred with greater frequency in women (72%). A higher percentage of participants aged <50 years (72.5%) were overweight/obese than those aged 50-64 (70%) and 65+ (61.4%). Level of ID and residence type were significantly associated with weight status (P < 0.001), with overweight/obesity more prevalent in mild (85.7%) than moderate (72%) or severe/profound ID (51.4%). Of those who lived independently/with family, 78.4% were overweight/obese, as were 74% living in a community group home (P < 0.001). Almost all overweight/obese participants' waist measurements were in the substantially increased risk of metabolic disease waist measurement category (92%, P < 0.001). Logistical regression used to model CHCs on BMI showed significant association between BMI and gastrointestinal tract [odds ratio (OR) = 0.57, P < 0.008, 95% confidence interval (CI) = (0.37; 0.86)], respiratory condition [OR = 8.95, P < 0.004, 95% CI = (2.57; 56.72)] and musculoskeletal disorders [OR = 0.40, P < 0.001, 95% CI = (0.25; 0.63)]. CONCLUSIONS The findings illustrate the strong cross-sectional association between overweight/obesity and CHCs. These findings suggest a need to prioritise weight status as a health risk to people with ID as they age.
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Affiliation(s)
- J Ryan
- Trinity Center for Ageing and Intellectual Disability, School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - P McCallion
- Temple School of Social Work, Temple University College of Public Health, Philadelphia, PA, USA
| | - M McCarron
- Trinity Center for Ageing and Intellectual Disability, School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - R Luus
- Department of Statistics and Population Studies, University of the Western Cape, Cape Town, South Africa
| | - E A Burke
- Trinity Center for Ageing and Intellectual Disability, School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
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Bourne MJ, Smeltzer SC, Kelly MM. Healthcare inequities among adults with developmental disability: An integrative review with implications for nursing education. Nurse Educ Pract 2021; 57:103225. [PMID: 34649127 DOI: 10.1016/j.nepr.2021.103225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/23/2021] [Accepted: 09/29/2021] [Indexed: 11/29/2022]
Abstract
AIM This integrative review synthesized research on the healthcare inequities experienced by adults with developmental disability in the United States and discussed implications for nursing education. BACKGROUND Individuals with developmental disability are living longer with chronic comorbidities and experience healthcare inequities. METHOD Application of inclusion criteria to database and ancestry searches resulted in 26 articles that were assessed for quality and analyzed thematically. RESULTS Three categories of inequity were identified: knowledge deficits, communication challenges and poor quality of care. Knowledge deficits and communication challenges can lead to frustration, errors and unmet needs. Poor quality of care encompasses the decreased availability and access to services, limited health promotion participation and higher rates of hospitalizations and complications for adults with developmental disability. CONCLUSION Healthcare inequities may be reduced by targeting patient and provider knowledge. Inclusion of developmental disability content and clinical experiences in nursing education may improve care and reduce inequities for this underserved population.
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Affiliation(s)
- Melissa J Bourne
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA 19085, USA.
| | - Suzanne C Smeltzer
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA 19085, USA.
| | - Michelle M Kelly
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA 19085, USA.
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P. Albuquerque C. Needs of older people with intellectual disabilities: variables influencing inter-respondent (client vs staff) agreement. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2021; 69:256-264. [PMID: 37025327 PMCID: PMC10071974 DOI: 10.1080/20473869.2021.1952825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 06/19/2023]
Abstract
Background: The importance of understanding the needs of older people with intellectual disabilities (IDs) is obvious, but the research available is limited. This study identifies the self-reported needs of older adults with IDs and compares them with staff reported needs regarding the same older adults with ID, therefore specifying and explaining agreements and disagreements. Method: The needs of 96 older adults with IDs were assessed through the Inventory of Identification of Needs (informant and self-report versions). Results: Both older people with IDs and staff reported quite diverse needs related to all the domains assessed by the IIN: physical health, literacy, information, meaningful activity, participation in the community, mental health, basics needs and accommodation. All the mean scores of the informant version of the IIN were higher than the ones of the self-report version. Agreement amongst informants was influenced by the prominence of needs, the accessibility to and the subjectivity of the information, and social desirability. Conclusions: A consumer-driven approach implies that services should be based on the needs identified.
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Affiliation(s)
- Cristina P. Albuquerque
- University of Coimbra, Center for Research in Neuropsychology and Cognitive and Behavioural Intervention, Faculty of Psychology and Educational Sciences, Coimbra, Portugal
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McCausland D, Guerin S, Tyrrell J, Donohoe C, O'Donoghue I, Dodd P. A qualitative study of the needs of older adults with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:1560-1568. [PMID: 34124818 DOI: 10.1111/jar.12900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 03/11/2021] [Accepted: 04/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Research indicates that adults with intellectual disabilities are living longer. However, there is limited research on how this affects health and care needs. OBJECTIVE The present study aimed to examine the health and social care needs of older adults with intellectual disabilities in Ireland using multiple informants. METHODS Data were gathered from a sample of 20 adults aged 50 years or older (Mean = 59.1, SD = 5.9, range = 50-72; 11 female). The sample included individuals with mild (n = 7), moderate (n = 10) and severe/profound (n = 3) intellectual disabilities. Additional data from keyworkers (n = 19) and family carers (n = 15) provided a more complete understanding of needs. RESULTS Results revealed some areas of agreement and difference between adults with intellectual disability and their carers regarding the social care, employment, retirement, physical and mental health needs of this population. CONCLUSIONS The findings of this study have potential implications for the provision of high-quality services for older adults with intellectual disabilities.
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Affiliation(s)
| | - Suzanne Guerin
- UCD School of Psychology, University College Dublin, Dublin 4, Ireland
| | | | - Clare Donohoe
- St Michael's House Disability Services, Dublin 9, Ireland
| | | | - Philip Dodd
- St Michael's House Disability Services, Dublin 9, Ireland
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Alftberg Å, Johansson M, Ahlström G. Ambivalence among staff regarding ageing with intellectual disabilities: Experiences and reflections. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2021; 25:192-209. [PMID: 31570036 PMCID: PMC8120636 DOI: 10.1177/1744629519874997] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/12/2019] [Indexed: 06/10/2023]
Abstract
This study explores the experiences and reflections of staff in intellectual disability (ID) services concerning ageing with ID. Qualitative interviews were conducted with 24 staff members in group homes and daily activity centres. The findings showed that the staff were uncertain about the signs of ageing in people with intellectual disabilities; they compared the life conditions of these people with conditions in older people without intellectual disabilities. Their emphasis on an active lifestyle was very strong. The staff members also mentioned uncertainty about how to facilitate assistive devices and whether 'ageing in place' was the best solution. The overall theme was manifested as ambivalence where notions of older people with intellectual disabilities seemed incompatible with notions of old age in general and could be explained by the theoretical concept of age coding. The findings of this study indicate the need to provide education about ageing to staff working in ID services.
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Affiliation(s)
| | | | - Gerd Ahlström
- Gerd Ahlström, Department of Health Sciences, Faculty of Medicine, Lund University, SE-221 00 Lund, Sweden.
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Schaap FD, Dijkstra GJ, Reijneveld SA, Finnema EJ. Use of dementia care mapping in the care for older people with intellectual disabilities: A mixed-method study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 34:149-163. [PMID: 32812319 PMCID: PMC7818226 DOI: 10.1111/jar.12794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 06/26/2020] [Accepted: 07/23/2020] [Indexed: 01/10/2023]
Abstract
Background The ageing of people with intellectual disabilities, with associated morbidity like dementia, calls for new types of care. Person‐centred methods may support care staff in providing this, an example being Dementia Care Mapping (DCM). DCM has been shown to be feasible in ID‐care. We examined the experiences of ID‐professionals in using DCM. Methods We performed a mixed‐methods study, using quantitative data from care staff (N = 136) and qualitative data (focus‐groups, individual interviews) from care staff, group home managers and DCM‐in‐intellectual disabilities mappers (N = 53). Results DCM provided new insights into the behaviours of clients, enabled professional reflection and gave new knowledge and skills regarding dementia and person‐centred care. Appreciation of DCM further increased after the second cycle of application. Conclusion DCM is perceived as valuable in ID‐care. Further assessment is needed of its effectiveness in ID‐care with respect to quality of care, staff‐client interactions and job performance.
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Affiliation(s)
- Feija D Schaap
- Research Group Living, Wellbeing and Care for Older People, NHL Stenden University of Applied Sciences, Leeuwarden, The Netherlands.,Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Geke J Dijkstra
- Research Group Living, Wellbeing and Care for Older People, NHL Stenden University of Applied Sciences, Leeuwarden, The Netherlands.,Department of Health Sciences, Applied Health Research, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sijmen A Reijneveld
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Evelyn J Finnema
- Research Group Living, Wellbeing and Care for Older People, NHL Stenden University of Applied Sciences, Leeuwarden, The Netherlands.,Department of Health Sciences, Nursing Research, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Ageing in place together: older parents and ageing offspring with intellectual disability. AGEING & SOCIETY 2020. [DOI: 10.1017/s0144686x20001038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractLimited research has been conducted about ageing in place among older parents who co-habit with their ageing offspring with intellectual disability (ID). This study aims to explore which older parents would choose ageing in place together with their ageing offspring with ID instead of moving and what factors are associated with this choice. A face-to-face interview was conducted using the ‘housing pathways’ framework with older parents (⩾60 years) co-habiting with their ageing offspring with ID (⩾40 years) from two local authorities in Taiwan. In total, 237 families completed our census survey between June and September 2015. The results showed that 61.6 per cent of the participants would choose ageing in place with their ageing offspring with ID, while 38.4 per cent of the participants would stay in their previous place without their disabled children, move in with their other children or move to a nursing home. Logistic regression analyses revealed that parents who preferred ageing in place together with their offspring with ID were more likely to own a house (‘personal control’), have higher levels of life satisfaction (‘self-esteem’) and satisfaction with their current community (‘self-identity’), and have a lower level of social support than parents who chose another option. To meet the needs of older parents and their ageing offspring with ID, care and housing transitions should be considered as part of long-term care policy.
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Chronic Health Conditions in Aging Individuals with Intellectual Disabilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093126. [PMID: 32365862 PMCID: PMC7246565 DOI: 10.3390/ijerph17093126] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/23/2020] [Accepted: 04/27/2020] [Indexed: 12/21/2022]
Abstract
Life expectancy of people with intellectual disability (ID) has increased in recent decades. However, there is little evidence of whether these extra years of life are spent in good health. The aim of this study, conducted in Spain, is to obtain information about the prevalence of chronic health conditions in people with ID over the age of 44 and compare it with that of their peers without disability. Twenty health conditions were analyzed in 1040 people with ID and 12,172 people without ID through a study of their prevalence. The findings show that chronic constipation, urinary incontinence, thyroid disorders and obesity are the most prevalent chronic diseases among individuals with ID. In addition, this population group suffers these health conditions more frequently than older adults without ID. Detection and early intervention in these health conditions will improve adequate access to social health services and subsequent treatment of aging adults with ID.
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Bauer A, Taggart L, Rasmussen J, Hatton C, Owen L, Knapp M. Access to health care for older people with intellectual disability: a modelling study to explore the cost-effectiveness of health checks. BMC Public Health 2019; 19:706. [PMID: 31174506 PMCID: PMC6556058 DOI: 10.1186/s12889-019-6912-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 04/29/2019] [Indexed: 01/09/2023] Open
Abstract
Background Whilst people with intellectual disability grow older, evidence has emerged internationally about the largely unmet health needs of this specific ageing population. Health checks have been implemented in some countries to address those health inequalities. Evaluations have focused on measuring process outcomes due to challenges measuring quality of life outcomes. In addition, the cost-effectiveness is currently unknown. As part of a national guideline for this population we sought to explore the likely cost-effectiveness of annual health checks in England. Methods Decision-analytical Markov modelling was used to estimate the cost-effectiveness of a strategy, in which health checks were provided for older people with intellectual disability, when compared with standard care. The approach we took was explorative. Individual models were developed for a selected range of health conditions, which had an expected high economic impact and for which sufficient evidence was available for the modelling. In each of the models, hypothetical cohorts were followed from 40 yrs. of age until death. The outcome measure was cost per quality-adjusted life-year (QALY) gained. Incremental cost-effectiveness ratios (ICER) were calculated. Costs were assessed from a health provider perspective and expressed in 2016 GBP. Costs and QALYs were discounted at 3.5%. We carried out probabilistic sensitivity analysis. Data from published studies as well as expert opinion informed parameters. Results Health checks led to a mean QALY gain of 0.074 (95% CI 0.072 to 0.119); and mean incremental costs of £4787 (CI 95% 4773 to 5017). For a threshold of £30,000 per QALY, health checks were not cost-effective (mean ICER £85,632; 95% CI 82,762 to 131,944). Costs of intervention needed to reduce from £258 to under £100 per year in order for health checks to be cost-effective. Conclusion Whilst findings need to be considered with caution as the model was exploratory in that it was based on assumptions to overcome evidence gaps, they suggest that the way health systems deliver care for vulnerable populations might need to be re-examined. The work was carried out as part of a national guideline and informed recommendations about system changes to achieve more equal health care provisions. Electronic supplementary material The online version of this article (10.1186/s12889-019-6912-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Annette Bauer
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London, England, WC2A 2AE, UK.
| | - Laurence Taggart
- Institute of Nursing & Health Research, Ulster University, N Ireland, Newtownabbey, BT37 0QB, UK
| | - Jill Rasmussen
- Royal College of General Practitioners (RCGP), 30 Euston Square, London, England, NW1 2FB, UK
| | - Chris Hatton
- Centre for Disability Research, Division of Health Research, Lancaster University, Lancaster, England, LA1 4YG, UK
| | - Lesley Owen
- National Institute for Health and Care Excellence, 10 Spring Gardens, London, England, SW1A 2BU, UK
| | - Martin Knapp
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London, England, WC2A 2AE, UK
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Roll AE, Bowers BJ. Promoting Healthy Aging of Individuals With Developmental Disabilities: A Qualitative Case Study. West J Nurs Res 2016; 39:234-251. [PMID: 27621273 DOI: 10.1177/0193945916668329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This qualitative case study sought to examine an innovative community outreach nursing program designed to promote healthy aging for more than 250 individuals with intellectual or developmental disabilities living in the community. We analyzed 10 in-depth interviews, one focus group, and various documents using thematic analysis. We researched why the program emerged and found the reasons to be improving the communication with primary care providers, providing person-centered health care, and building on and contributing to existing community-based programs. Findings on what the daily work of community outreach nurses with individuals with intellectual or developmental disabilities entailed, included person-centered health education, advocacy for the safe return home, support for staff to understand that health issues can lead to behavior changes, and enabling social participation. This case study may inspire further research or help others develop similar programs.
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Affiliation(s)
- Anne E Roll
- 1 University of Wisconsin-Madison, WI, Madison, WI, USA
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Ward K, Hoare KJ, Gott M. Evolving from a positivist to constructionist epistemology while using grounded theory: reflections of a novice researcher. J Res Nurs 2015. [DOI: 10.1177/1744987115597731] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Specifying epistemology guiding health research provides evidence of a researcher’s worldview and thus the rationale for methodological choices. A challenging quagmire of epistemological options exists for the novice nurse researcher, often difficult to navigate, particularly in the absence of a philosophical grounding. During her doctoral journey, the first author (KW) explored living with overnight mask ventilation for sleep apnoea using a social constructionist grounded theory. Choosing this methodology required that KW reconcile her background in evidence-based nursing practice with the various theoretical legacies underpinning grounded theory. In this paper, the philosophical roots of both evidence-based nursing and grounded theory are explored. The influence that both context and the researcher’s relationship with their participants and data have upon knowledge construction is also considered. Parallels are drawn between a developing awareness of epistemology and the evolution of grounded theory research from positivism to social constructionism. This paper will assist novice researchers to consider assumptions about the origins of knowledge and subsequently be of help when choosing a research methodology.
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Affiliation(s)
- Kim Ward
- Teaching Fellow, School of Nursing, The University of Auckland, New Zealand
| | - Karen J Hoare
- Senior Lecturer and NP Children & Youth Primary Health Care, School of Nursing, The University of Auckland, New Zealand
| | - Merryn Gott
- Professor of Health Sciences and Associate Deputy Vice Chancellor (Research) & Director of Research, School of Nursing, The University of Auckland, New Zealand
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