Search

Background Sleep–wake problems and depressive symptoms are common in people with intellectual disabilities (IDs) and are thought to be related to the unstable sleep–wake rhythm in this population. Previously, we showed that after increasing environmental light exposure, mid-sleep and sleep onset advanced, and mood improved over a period of 14 weeks after installing environmental dynamic light installations in the living room of people with IDs. We invited participants of that short-term study to take part in the current study on sleep–wake rhythm, mood and behaviour in older adults with IDs 1 year after installing environmental dynamic light installations in the common living rooms of six group homes. Methods A pre–post study was performed from October 2017 to February 2019. We included 45 participants (63.5 ± 8.5 years, 67% female) from six group home facilities who provided data at baseline (9, 4 and 1 weeks prior to installing light installations), short term (3, 7 and 14 weeks after installing light installations) and 1 year (54 weeks after installing light installations). Wrist activity was measured with actigraphy (GENEActiv) to derive the primary outcome of interdaily stability of sleep–wake rhythms as well as sleep estimates. Mood was measured with the Anxiety, Depression and Mood Scale. Behaviour was measured with the Aberrant Behaviour Checklist. Results One year after installing dynamic lighting, we did not find a change in interdaily stability. Total sleep time decreased (β = −25.40 min; confidence interval: −10.99, −39.82), and sleep onset time was delayed (β = 25.63 min; confidence interval: 11.18, 40.08). No effect on mood or behaviour was found. Conclusions We did not find a change in sleep–wake rhythm, mood or behaviour in older persons with IDs living in care facilities 1 year after installing the light. We did find evidence for a long-term effect on sleep duration and sleep timing. The results have to be interpreted with care as the current study had a limited number of participants. The need for more research on the long-term effects of enhancing environmental light in ID settings is evident. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The article discusses updates to systematic review evidence concerning what are termed psychosocial interventions that serve older adults with serious mental illness (OASMI), in addition to the evolution of rehabilitation services in a particular mental health facility in the midwestern U.S. It examines mental health recovery, and the connection between ageism and mental health.

The purpose was to examine the effects of type of program (integrated vs. segregated) and type of sport (basketball vs. swimming) on sport skills, four domains of perceived competence, and general self-worth, Participants were 48 adolescent females with mental retardation (MR) divided equally into six groups: Ca) segregated basketball. (b) integrated basketball, (c) segregated swimming, (d) integrated swimming, (el adapted physical activity (APA), (f) sedentary. The experimental treatment was 8 months long. We administrated sport skill tests and Harter's (1985) Self-Perception Profile for Children four times to determine changes in sport skill, perceived competence, and general self-worth. Results indicated (a) significant improvement in skill for all sports groups, (b) no changes in perceived social acceptance and physical appearance, (c) significantly lower perceived athletic competence for the integrated basketball group compared to the sedentary group, (d) significantly lower perceived conduct for the basketball groups compared to the APA and sedentary groups, (e) and no significant changes in general self-worth. [ABSTRACT FROM AUTHOR]

Aim: This study explored patterns of service use and associated socioeconomic factors among Chinese elders with mental disabilities. Methods: Data from the second China National Sample Survey on Disability (CNSSD) were used in this study. Univariate and multivariate logistic regression models were used to calculate the odds ratios and 95% confidence intervals for factors associated with utilization of mental health services among Chinese elderly people with a mental disability. Results: Among elderly people with a mental disability in the CNSSD, 46.35% had used mental health services. Urban residence, higher education level, being married, medical insurance coverage, and higher annual family income per capita were associated with more utilization of mental health services. Conclusions: This study revealed a low level of mental health service utilization among the Chinese population with mental disorders or a mental disability. Strategies to improve the insurance coverage of mental healthcare, to increase public awareness of mental disorders, and to reduce regional inequality of mental health resources are warranted. [ABSTRACT FROM AUTHOR]

The accelerated growth of the percentage of elder people and persons with brain injury-related conditions and who are intellectually challenged are some of the main concerns of the developed countries. These persons often require special cares and even almost permanent overseers that help them to carry out diary tasks. With this issue in mind, we propose an automated schedule system which is deployed on a social robot. The robot keeps track of the tasks that the patient has to fulfill in a diary basis. When a task is triggered, the robot guides the patient through its completion. The system is also able to detect if the steps are being properly carried out or not, issuing alerts in that case. To do so, an ensemble of deep learning techniques is used. The schedule is customizable by the carers and authorized relatives. Our system could enhance the quality of life of the patients and improve their self-autonomy. The experimentation, which was supervised by the ADACEA foundation, validates the achievement of these goals. [ABSTRACT FROM AUTHOR]

The aim of the study was to compare the cognitive performances of adults with intellectual disability in two tests different in purposes, format, length, and ease of use: WAIS-IV battery for measuring full and factorial IQs, and Montreal Cognitive Assessment (MoCA) used for the evaluation of cognitive deterioration. The two tests were administered to a sample composed of 40 adults, 27 males and 13 females, diagnosed with Mild or Moderate Intellectual Disability (age range 16-64 years, mean age 35.70). No gender differences were detected. Results show that both the total IQ and the WAIS-IV factors are significantly correlated with MoCA score, except the Processing Speed. Verbal Comprehension is the best predictor of the impairment measured by MoCA. This result is confirmed by Multidimensional Scaling. Among the single WAIS-IV subscores only Puzzle and Cancellation show small correlations with MoCA score. The memory functions assessed by MoCA result different from those of WAIS Working memory, factor more close to the MoCA visuo-spatial subdomain.Some implications for the assessment of the cognitive impairment in adults with Intellectual disability are underlined. [ABSTRACT FROM AUTHOR]

Purpose: Veterans with dementia and their caregivers in remote areas may not have access to specialists to provide diagnosis, treatment, and education. The purpose of this clinical demonstration project was to examine the feasibility, acceptability, and impact of a video consultations clinic for veterans with dementia or memory complaints and their caregivers. Methods: The dementia clinical video telehealth (CVT) consultation clinic was established to identify, diagnose, and treat dementia in veterans at sites distant from the main medical center. A geriatrician at the main facility provided video consultation to patients and caregivers at seven satellite facilities. Diagnoses made and services provided were recorded after the initial consultation. Patient and caregiver satisfaction with the CVT clinic were assessed. Findings: Ninety-four patients were evaluated in the CVT dementia clinic (average age = 74.7; average Mini-Mental State Exam = 24.4). Forty patients had a prior dementia diagnosis, 15 received a new dementia diagnosis, and 20 a new mild cognitive impairment diagnosis. Of the remaining patients evaluated for memory complaints, seven were found to have depression, three had hearing loss, and three had traumatic brain injury. After CVT consultation, common referrals included social work (n = 43), neuropsychology (n = 36), and brain imaging (n = 26). Patients and caregivers expressed high satisfaction with the video consultation and 90% of caregivers indicated they would rather use CVT than travel to see the specialist in person. Conclusions: Video consultation was well accepted by both dementia patients and caregivers. CVT may facilitate timely diagnosis and management and provide support for rural dementia patients and caregivers. [ABSTRACT FROM AUTHOR]

AIMS The drug burden index (DBI) is a dose-related measure of anticholinergic and sedative drug exposure. This cross-sectional study described DBI in older adults with intellectual disabilities (ID) and themost frequently reported therapeutic classes contributing to DBI and examined associations between higher DBI scores and potential adverse effects as well as physical function. METHODS This study analysed data from Wave 2 (2013/2014) of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), a representative study on the ageing of people with ID in Ireland. Self- and objectively-reported data were collected on medication use and physical health, including health conditions. The Barthel index was the physical function measure. RESULTS The study examined 677 individuals with ID, of whom 644 (95.1%) reported taking medication and 78.6% (n = 532) were exposed to medication with anticholinergic and/or sedative activity. 54.2% (n = 367) were exposed to high DBI score (≥1). Adjusted multivariate regression analysis revealed no significant association between DBI score and daytime dozing, constipation or falls. After adjusting for confounders (sex, age, level of ID, comorbidities, behaviours that challenge, history of falls), DBI was associated with significantly higher dependence in the Barthel index (P = 0.002). CONCLUSIONS This is the first time DBI has been described in older adults with ID. Scores were much higher than those observed in the general population and higher scores were associated with higher dependence in Barthel index activities of daily living. [ABSTRACT FROM AUTHOR]

People with intellectual disabilities have increased life expectancy compared to just a few decades ago, and there is a lack of knowledge about the experiences of transition into retirement for this group. In this study, semi-structured in-depth interviews with seven retirees with intellectual disabilities were conducted in order to investigate their reasons for retirement, experiences of the transition, their activities and satisfaction with their lives as retirees. Data was analysed with systematic text condensation. Most participants described that, although they experienced the retirement process and transition as abrupt, retirement had a positive impact on health, satisfaction and self-determination. Findings in this novel study in a Nordic context are need of increased knowledge on ageing and retirement among people with intellectual disabilities, and that individual guidance might improve their transition into retirement. [ABSTRACT FROM AUTHOR]

Background: Although people with intellectual disability (ID) and people with dementia have high drug prescription rates, there is a lack of studies investigating drug use among those with concurrent diagnoses of ID and dementia.Aim: To investigate the use of antipsychotics, benzodiazepine derivatives, and drugs recommended for dementia treatment (anticholinesterases [AChEIs] and memantine) among people with ID and dementia.Methods and Procedures: Having received support available for people with ID and/or autism spectrum disorder (ASD) was used as a proxy for ID. The ID cohort consisted of 7936 individuals, aged at least 55 years in 2012, and the referent cohort of age- and sex-matched people from the general population (gPop). People with a specialists' diagnosis of dementia during 2002-2012 were identified (ID, n=180; gPop, n=67), and data on prescription of the investigated drugs during the period 2006-2012 were collected.Outcome and Results: People with ID/ASD and dementia were more likely than people with ID/ASD but without dementia to be prescribed antipsychotics (50% vs 39% over the study period; odds ratio (OR) 1.85, 95% confidence interval 1.13-30.3) and benzodiazepine derivatives (55% vs 36%; OR 2.42, 1.48-3.98). They were also more likely than people with dementia from the general population to be prescribed antipsychotics (50% vs 25%; OR 3.18, 1.59-6.34), but less likely to be prescribed AChEIs (28% vs 45%; OR 0.32, 0.16-0.64). [ABSTRACT FROM AUTHOR]

Background Many risk factors have been confirmed for poor bone health among the general population including age, gender and corticosteroid use. There is a paucity of investigation among people with intellectual disability; however, research points to differing risks namely anti-epileptic medication use, Down syndrome and poor behaviour lifestyle. Methods Data was extracted from the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing in Ireland. In total, 753 participants took part, and data was gathered on participants' health status, behavioural health, health screenings and activities of daily living. The prevalence of osteoporosis and related risk factors were specifically examined. Results Overall, 8.1% reported a doctor's diagnosis of osteoporosis with over 20% reporting history of fracture. Risk identified included older age ( P < 0.0001), female gender ( P < 0.0001), difficulty walking ( P < 0.0001) with older age and being female the stronger predictors for osteoporosis, odds ratio = 6.53; 95% confidence interval 2.82-15.11 and odds ratio = 4.58; 95% confidence interval 2.29-9.17, respectively. There was no gender difference regarding the level of fractures; however, epilepsy and anti-epileptic medication were strong predictors. Overall, 11.1% attended for bone screening diagnostics. Conclusion Despite low levels of reported doctor's diagnosis of osteoporosis risk factor prevalence was high. Considering the insidious nature of osteoporosis and the low levels of diagnostic screening, prevalence could be possibly higher. [ABSTRACT FROM AUTHOR]

We wanted to find out what getting older feels like for people with learning disabilities. We asked seven people with learning disabilities about getting older. Most of the people had noticed changes as they got older. Some felt sad or angry about it. Some worried about getting older. People said that it was important to have good friends and to do useful jobs. Some people did not know much about getting older. Some people wanted to look back over their lives to feel more settled. They might need help with this. Not enough is currently known about how people with learning disabilities experience and understand the ageing process. This is particularly important as the population of older people with learning disabilities is growing due to increased life expectancy. This article draws on the first author's doctoral research study, which aimed to fill this gap in the literature by exploring how people with learning disabilities experience and make sense of the ageing process and old age. Seven people with learning disabilities aged 60 or more were interviewed, and their accounts were analysed using interpretative phenomenological analysis. This approach allows the participant's lived experience to be explored in detail. Participants' accounts were analysed individually, followed by a group analysis. This article presents the results of the group analysis, illustrated by quotes from individuals. The master themes arising from the group analysis were as follows: quality of relationships is central to enjoyment of life, including subthemes on the importance of affection and companionship, distress at lack of closeness and anxiety about ability to satisfy others; powerlessness; needing a sense of purpose; and making sense of getting older, including subthemes on reactions to changes with age, life review and looking to the future. Clinical implications of the findings include the need for services to support older people with learning disabilities in maintaining friendships and meaningful activities. This study demonstrates that some older people with learning disabilities can engage in a process of life review and raises the possibility that learning disability services could play a useful role in facilitating this process. Understanding of the ageing process varied between participants and tended towards a negative, stereotypical view of ageing. The findings suggest that people with learning disabilities could benefit from psychoeducation on the ageing process to aid them in making sense of the changes they experience as they get older. [ABSTRACT FROM AUTHOR]

This paper is about older people with learning disabilities who live in the country in Australia. We talked to both individuals and their carers to find out what things helped them they got older, and what things made it harder. These people said that they were well supported by the local community and particularly their doctors. However, many people in this project also reported problems about living in the country such as limited choices and being forced to make decisions they did not like. Access to support services in rural areas is known to be problematic both in Australia, and in other countries around the world, but the majority of research on the population of people ageing with learning disability has so far focussed on metropolitan residents. The authors report about select aspects of the lived experience of older adults with learning disability resident in rural locations in two states of Australia. This pilot project examined data drawn from 34 semi-structured interviews conducted with 17 older adults and 17 carers. Responses were analysed for thematic areas. It was observed that the capacity of certain rural areas to support meaningful choice-making was limited due to constraints of access to key services, including community-based aged care, generic and specialist health services, and both supported disability and aged-care residential options. Responses indicated that those living in both small- and medium-sized congregate care settings (such as group homes and residential aged-care facilities) had more limited choices and only partial (if any) control over their living situation. An understanding of the needs of older adults with learning disability resident in rural areas is important to ensure that both aged-care and disability support structures are built on individuals' needs. [ABSTRACT FROM AUTHOR]

Accessible summary More people with learning disabilities are living longer. This is a good news story! But, the bad news is that they do not live as long as the rest of the population., Health and other services need to be better organised to ensure that people with learning disabilities get better healthcare and other services which would help them lead more healthy lives., Most older people with learning disabilities live at home with their Mum or Dad, who are getting older too and find life more difficult. Care and support services need to adapt as families' needs change, but often this does not happen., We need to know more about these problems, which people with learning disabilities and their family carers face as they get older., This article looks at what we know and what more we need to find out to help older people with learning disabilities and their family carers live happier and healthier lives., Abstract Background: Growing numbers of people with learning disabilities are now living into older age. This study aims to examine the state of knowledge about their lives and the challenges that ageing has for both family carers and policymakers and practitioners. Materials and Methods: The article synthesises existing research in the fields of learning disability, ageing and family and social care with a view to learning lessons from these separate fields, identifying possibilities for collaboration and identifying gaps in knowledge. Results: The article concludes that existing research in the fields of ageing and family and social care can add significantly to an understanding of the impact of ageing on people with learning disabilities and their carers but, to date, there has been little collaboration or sharing of knowledge between the three areas. Conclusion: The article concludes that further research is required to fully understand the impact of ageing on the quality of life of people with learning disabilities and their family carers and to inform the design and delivery of services. A useful and productive way forward would be learn from and to work with researchers in cogniscent fields, notably, but not only, in the fields of social gerontology and family and social care. [ABSTRACT FROM AUTHOR]

People with learning disabilities are living longer. Older people with learning disabilities should be included in policies and plans that are for all older people. National plans and policies for older people often do not say anything about older people with learning disabilities, and it is hard to know whether older people with learning disabilities are benefiting. People who plan services locally often do not have good information on older people with learning disabilities. Using the Equalities Act 2010 could help people who plan services and write policy to think about older people with learning disabilities but this is not happening at the moment. People who work with older people with learning disabilities should be aware of policy for all older people, so that older people with learning disabilities do not miss out. This paper seeks to explore the opportunities and challenges generated by current policy, guidance and legislation in England relating to older people, in terms of the practical implications for older people with learning disabilities. Using the broad themes housing, employment, social inclusion and isolation, care and support, and promoting better health and well-being, this paper discusses potential practical opportunities and concerns for older people with learning disabilities arising from policy and legislation such as current initiatives regarding integration, personalisation and the dementia policy. Consideration is given to the implications of changing policy and practice for both current and future generations of people with a learning disability as they reach older age. This discussion paper concludes that whilst there is potential for older people with a learning disability to benefit from policy and practice aimed at improving the lives of older people generally, the tendency for policy to be targeted at specific groups without adequately considering the diversity of those groups often leaves those with a learning disability at the margins of being able to make the most of changes. [ABSTRACT FROM AUTHOR]

Building on the findings of the 2003 meeting, Keeping the Promises: National Goals, State of Knowledge and Research Agenda for Persons with Intellectual and Developmental Disabilities, the intended outcomes of the 2015 National Goals in Research, Practice and Policy Conference were to outline a vision for the future and leadership of research, practice, and policy in intellectual and developmental disabilities (IDD). At the National Goals 2015 Conference held August 6-7, 2015, in Washington, D.C., 12 members of a designated strand on aging were charged to discuss the research and gaps in evidence specific to the context of transitions in aging associated with health, retirement, and end of life. The strand was comprised of a strand leader, research mentor, policy consultant, conference liaison and eight other participants with expertise and experience in aging among people with intellectual and developmental disabilities. Explored in relative detail are the four goals, rationale, and implications for research, practice and policy to facilitate a positive and person-centered approach to supporting people with IDD as they age and face these transitions in late-life. [ABSTRACT FROM AUTHOR]

Introduction Although evidence suggests physical activity (PA) may be associated with mental well-being at older ages, it is unclear whether some types of PA are more important than others. The purpose of this study is to investigate associations of monitored total PA under free-living conditions, self-reported leisure-time PA (LTPA), and walking for pleasure with mental well-being at age 60–64 years. Methods Data on 930 (47%) men and 1,046 (53%) women from the United Kingdom Medical Research Council (MRC) National Survey of Health and Development collected in 2006–2011 at age 60–64 were used in 2013–2014 to test the associations of PA (PA energy expenditure and time spent in different intensities of activity assessed using combined heart rate and acceleration monitors worn for 5 days, self-reported LTPA, and walking for pleasure) with the Warwick-Edinburgh Mental Well-being Scale (WEMWBS; range, 14–70). Results In linear regression models adjusted for gender, long-term limiting illness, smoking, employment, socioeconomic position, personality, and prior PA, those who walked for >1 hour/week had mean WEMWBS scores 1.47 (95% CI=0.60, 2.34) points higher than those who reported no walking. Those who participated in LTPA at least five times/month had WEMWBS scores 1.25 (95% CI=0.34, 2.16) points higher than those who did not engage in LTPA. There were no statistically significant associations between free-living PA and WEMWBS scores. Conclusions In adults aged 60–64 years, participation in self-selected activities such as LTPA and walking are positively related to mental well-being, whereas total levels of free-living PA are not. [ABSTRACT FROM AUTHOR]

BACKGROUND: According to the Alzheimer's Disease 2014 Facts and Figures report, an estimated 5 million older Americans are living with Alzheimer's disease (AD). AD is the sixth leading cause of death in the United States and the only 1 among the top 10 that cannot be prevented, cured, or even slowed. Predictably, AD puts an enormous cost burden on the U.S. health care system, with costs expected to soar to $1.2 trillion in 2050. Many individuals with minor cognitive impairment do not seek treatment and/or delay treatment until perceptible deficits indicative of moderate stage of disease are present. Several new drugs for AD are under development based on etiological disease theories, but their long-term impact on cognition and/or function is unclear. One potential treatment is to address low serum 25-hydroxy vitamin D (25[OH]D). METHODS: We performed a literature review on the topic of low vitamin D levels and cognition in geriatric patients. RESULTS: Recent studies have associated low vitamin D levels with cognitive complaints, impairment, and AD in geriatric patients; however, there is a dearth of prospective studies on the topic. CONCLUSIONS: Available data suggest that more research is needed to promote a better understanding of vitamin D levels and incident AD. [ABSTRACT FROM AUTHOR]

Persons with a mental disorder may suffer problems of social exclusion and their rights can be violated in different spheres. By paternalism, ignorance or prejudice, this situation can also occur in the care provided by professionals. The provision of high quality professional services implies an approach that promotes the knowledge and the protection of the fundamental rights of persons attended, facilitating in this way the fight against stigma and the development of a recovery model. The aim in though this review is: 1. Reflect on the protection of the rights and the consequences of stigma in the recovery process of persons suffering from a mental disorder. 2. Consider some aspects related to capacity, informed consent and the Psichiatric Advance Directives. 3. Bring up elements for discussion on involuntary outpatient treatment and possible alternatives. [ABSTRACT FROM AUTHOR]

The aim of this paper is to examine whether the protection of elderly people with an intellectual disability by the done-guard --the most frequently used legal mechanism-- is adequate to protect the personal and financial interests of these seniors and, if the legal treatment given to this figure in the Spanish law meets the objectives set out in art. 12 of the Convention on the Rights of Persons with Disabilities and its Optional Protocol, adopted on the 13th of December 2006 by the United Nations General Assembly. [ABSTRACT FROM AUTHOR]

The emerging phenomenon of ageing with an intellectual disability has become subject to an increasing research focus in recent years. However, there remains little knowledge regarding the specific impediments that community workers face in supporting this cohort. The aims of the current study were to identify the major factors that, direct care staff believe, have most impact upon individuals ageing with an intellectual disability in the community. A three-round Delphi project was conducted across rural areas of New South Wales in Australia with 31 disability support workers to gain their perspectives on the main impediments facing a person ageing with intellectual disability. The 2010 study identified that the issue of ageing with an intellectual disability was presenting significant problems for community-based service delivery to this group of people. The panel identified 25 different impediments to the provision of support. A thematic analysis of the items indicated three main themes of 'funding', 'training' and 'access to services'. By identifying these impediments to supporting people ageing with an intellectual disability in the community, both services and government funding bodies have the ability to plan to overcome both current and future problem areas. This identification of impediments may facilitate individuals to receive more appropriate assistance, which in turn may lead to an improved quality of life and maintenance of a communitybased placement rather than premature admission to the congregate-care system. This study is particularly timely, given that Australia is in the midst of implementing a National Disability Insurance Scheme, and is an opportunity for all levels of government to agree on the mechanisms to appropriately assist individuals with an intellectual disability to continue to be supported in the community as they age. [ABSTRACT FROM AUTHOR]

The article focuses on how to cure older adult with down syndrome (DS). Health care professionals are giving health prevention strategies, along with improved techniques for early diagnosis and intervention, for adults with DS. It further discusses unique physical features of DS, nursing management of person with DS and its pain assessment.

Highlights: [•] Low physical fitness levels are seen across the entire older ID population. [•] Older, female adults with more severe ID or Down syndrome are less fit. [•] Less active adults with mobility impairments and higher care needs are less fit. [•] Exercise interventions should target subgroups with lowest fitness levels first. [Copyright &y& Elsevier]

The aim of the study object of the present paper was to describe the characteristics of caregivers of older adults with dementia in a rural region, as well as the relationship between these characteristics and the perceived burden by their caregivers. The study used a cross-sectional population- based design with 15 primary caregivers as participants. Participants responded to the he Zarit's Caregiver Burden Interview and the Self-Report Questionnaire. Results indicate that the average adjusted scores of the Zarit Interview have a significantly correlation with caregiver's psychological morbidity, as well as the influence of several environmental context features on caregiver burden. Although Zarit scores were relatively low in comparison to those obtained in other studies, the authors recommend to increase the support given to caregivers and further implementing psychosocial interventions. [ABSTRACT FROM AUTHOR]

Highlights: [•] Elderly persons with ID fall more often than the general elderly population. [•] Fall risk is related to mild severity of ID and high physical activity. [•] Fall risk is also related to hyperactivity and visuo-motor and attention capacity. [•] Fall risk in elderly with ID is an interplay of personal and environmental factors. [•] Future research should focus on screening risk factors and fall prevention. [Copyright &y& Elsevier]

Objective The objective of this article is to study which factors are associated with depression and anxiety in older adults with intellectual disabilities (ID). Methods Depressive and anxiety symptoms were studied in 990 participants with borderline to profound ID, aged ≥ 50 years, using self-report and informant-report screening questionnaires. In 290 participants, major depression and anxiety disorders were assessed with a standardised psychiatric interview. Associations with personal, medical and psychosocial factors, which were collected through questionnaires and participants' medical and psychological records, were studied using multiple logistic regression analysis. Results Increased depressive symptoms were positively associated with increased anxiety symptoms, number of life events during the past year and chronic diseases (heart failure, stroke, chronic obstructive pulmonary disease, coronary artery disease, diabetes mellitus and malignity in the previous 5 years) and negatively with instrumental activities of daily living (IADL) abilities. Major depression was positively associated with chronic diseases and negatively with IADL abilities. Increased anxiety symptoms were positively associated with borderline or mild ID and increased depressive symptoms and negatively associated with Down syndrome, epilepsy and social contacts. Anxiety disorders showed no significant associations. Conclusions To develop effective prevention and treatment policies, factors associated with depression and anxiety in older adults with ID should be further examined in longitudinal research. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Self-injurious behavior (SIB) is a distressing type of problem behavior that may be exhibited in individuals with intellectual disabilities (IDs). This article provides an overview of SIB, its underlying causes and functions, as well as other key variables associated with its manifestation. Adults with IDs are routinely living longer. Given this rapidly emerging and expanding population, special attention is given to SIB in aging adults with IDs that may result from age-related risk factors. Risks include increasing and unresolved health issues, physical changes, declining physical abilities, transitions to new residential environments, and the potential for experiencing loss and bereavement. The article concludes with practice implications for social workers who may encounter older individuals with IDs and SIB. [ABSTRACT FROM AUTHOR]

Abstract: Older people with an intellectual disability (ID) have been shown to have similar to increased cardiovascular risks as compared to the general population. Peripheral arterial disease (PAD), atherosclerosis distal from the aortic bifurcation, is associated with increased cardiovascular morbidity and mortality. The prevalence of PAD has not been investigated in this population. Therefore, the aim of the present study was to determine the prevalence of PAD in older people with ID in The Netherlands, the rate of prior diagnoses, and correlations with participant characteristics, and to compare the prevalence with PAD in the general Dutch population. 771 people aged 50 years and over participated in ankle-brachial index (ABI) measurement as part of a multi-centre cross-sectional study (HA-ID study). PAD was defined as an ABI<0.9. After excluding those, who met the exclusion criteria, 629 participants remained. PAD was present in 20.7% of the participants and 97% had not been diagnosed before. People with higher age, smokers and people who lived in central settings, walked with support and were more dependent in activities of daily living were more at risk of PAD. Prevalence of PAD is higher than in the general population (17.4% of 562 eligible participants with ID, as compared to 8.1% of 917 Dutch participants of the PANDORA study, a pan-European study into the prevalence of PAD) through all age groups. Because the high prevalence of PAD implies a serious health risk for older people with ID, we recommend that ankle-brachial index measurement is to be routinely performed as part of the cardiovascular risk management in this group. [Copyright &y& Elsevier]

Abstract: Grip strength is an important predictor of several health outcomes in the general older population. Grip strength assessment is feasible and reliable in older adults with intellectual disabilities (ID), which makes it a valuable measurement for application in this population. The purpose of this study was to investigate the effect of handedness on grip strength in the older population with ID. Handedness and grip strength were assessed in a sample of 1050 older adults (≥50 years) with borderline to profound ID. Results showed that 26.2% of the study sample was left-handed. In right-handed participants the dominant hand (right) was on average 8.7% stronger than the non-dominant hand (p <0.001). For lefthanded participants there was no significant difference between the dominant hand (left) and nondominant hand. However, more detailed analyses revealed that 34.5% of the participants were stronger with their non-dominant hand, (on average 16.6% stronger for right-handed and 16.3% stronger for left-handed participants). Because of the large strength ratios, distributed in favor of both the dominant as the non-dominant hand, it is recommended to assess both hands to get a valid result of grip strength in older adults with ID. [Copyright &y& Elsevier]

Abstract: Prescribing pharmacotherapy for older individuals with an intellectual disability (ID) is a complex process, possibly leading to an increased risk of prescription errors. The objectives of this study were (1) to determine the prevalence of older individuals with an intellectual disability with at least one prescription error and (2) to identify potential risk factors for these prescription errors (age, gender, body mass index (BMI), frailty index, level of intellectual disability and living situation). The study population consisted of 600 older (≥50 years) individuals with an ID using one or more drugs who were randomly selected from the study cohort of the Healthy Ageing and Intellectual Disability (HA-ID) Study. The medication used at the time of measurement was screened for errors by a hospital pharmacist/clinical pharmacologist and a Master''s student pharmacy using consensus methodology. Participants with one or more prescription errors were compared to participants without prescription errors by multivariate logistic regression to identify potential risk factors. The prevalence of individuals with one or more prescription errors was 47.5% (285 of 600 individuals; 95% confidence interval (CI) 43–52%). Relevant errors, defined as errors that actually do require a change of pharmacotherapy, were identified in 26.8% of the individuals (161 of 600 individuals; 95% CI 23–30%). Higher age (adjusted odds ratio (ORadj) 1.03; 95% CI 1.01–1.06), less severe intellectual disability (moderate: ORadj 0.48; 95% CI 0.31–0.74 and severe: ORadj 0.56; 95% CI 0.32–0.98), higher BMI (ORadj 1.04; 95% CI 1.01–1.08), higher frailty index (0.39–0.54: ORadj 2.4; 95% CI 1.21–4.77 and ≥0.55: ORadj 3.4; 95% CI 1.03–11.02), polypharmacy (ORadj 8.06; 95% CI 5.59–11.62) and use of medicines acting on the central nervous system (ORadj 3.34; 95% CI 2.35–4.73) were independently associated with the occurrence of prescription errors. Interventions targeted to high risk patients should be designed and implemented to improve pharmacotherapy in older individuals with an intellectual disability. [Copyright &y& Elsevier]

Background: Although there is no strict definition of frailty, it is generally accepted as a state of high vulnerability for adverse health outcomes at older age. Associations between frailty and mortality, dependence, and hospitalization have been shown. We measured the frailty level of older people with intellectual disabilities (ID). Furthermore variation in gender, age, and level of ID were identified. Results were compared to a frailty study in the general European population. Methods: This research elaborates on a large cross-sectional study: Healthy Ageing with Intellectual Disability (HA-ID). Nine hundred-eighty-two men and women (≥50yr) with ID were included. Based on the collected data, we developed a frailty index with 51 health-related deficits, and calculated a frailty index score between 0 and 1 for each individual. Deficits included physical, social and psychological problems. Results: The mean frailty index score was 0.27 (standard deviation .13). Frailty was positively correlated with age (r =0.297, p <.001). More severe ID was associated with higher frailty scores (β =0.440, p <001). The upper limit of the FI was 0.69, which was consistent for all age categories. Conclusion: As people with ID are getting older, the question whether additional years are spent in good health becomes salient. Here, people with ID over age 50 had frailty scores similar to most elderly people over 75y. Future research is needed to confirm if frail elderly people with ID have an increased risk of adverse health outcomes. [Copyright &y& Elsevier]

We evaluated a commercially-available monitoring system for older people with dementia living at home. The system was designed to detect problems before they require crisis intervention. Fourteen clients from two healthcare organisations in the Netherlands used the system over a 9-month period. The formal and informal caregivers were interviewed, project group meetings were observed, nurse diaries were analysed and a cost analysis performed. Clients and informal caregivers reported enhanced feelings of safety and security as a result of having the system installed in the home. The system appeared to reduce the burden of care on the informal caregiver and had the potential to allow people to live at home for longer. There were financial savings for clients staying at home with the technology compared with the costs of staying in a nursing home: for 10 clients living at home for 2 months, the savings were 23,665 euro. The study showed that the monitoring system represents a potentially useful early warning system to detect a situation before it requires emergency intervention. [ABSTRACT FROM AUTHOR]

Mobility limitations are common in persons with Intellectual Disabilities (ID). Differences in balance and gait capacities between persons with ID and controls have mainly been demonstrated by instrumented assessments (e.g. posturography and gait analysis), which require sophisticated and expensive equipment such as force plates or a 3D motion analysis system. Most physicians and allied healthcare professionals working with persons with ID do not have such equipment at their disposal, so they must rely on clinical tests to determine whether balance and gait are affected. The aim of this study was to investigate whether existing clinical balance and gait tests are feasible in older persons with mild to moderate ID and to examine whether these tests are able to show limitations in balance and gait capacities in the ID population compared to age-matched peers in the general population. Furthermore, it was aimed to identify the most important determinants of balance and gait disability in persons with the ID. A total of 76 older persons with mild to moderate ID (43 male, mean age 63.1±7.6years) and 20 healthy controls (14 male, mean age 62.2±5.6years) participated. Balance and gait abilities were assessed with the Berg Balance Scale (BBS), the Functional Reach test (FR), the Timed Up and Go Test (TUGT), the timed Single Leg Stance (SLS) and the Ten Metre Walking Test (TMWT). Our study showed that it is feasible to conduct standard clinical balance and gait tests in older persons with mild to moderate ID. Balance and gait performance of persons with ID is substantially worse compared to older persons of the general population. Age, number of co-morbidities, Body Mass Index (BMI), body sway and fear of falling are associated with balance and gait performance in persons with ID. These factors might help in the selection of subjects to be monitored on their balance and gait capacities. [Copyright &y& Elsevier]

The number of people with intellectual disability living into old age continues to increase. As one ages, generally, functional ability decreases and health issues increase, with recognising and responding to the health needs of the person with intellectual disability of great importance and the responsibility of the intellectual disability nurse. The nurse must review and adjust the way they deliver care to ageing people with intellectual disability, not only in terms of responding to their health needs but also through collaborative working within teams and other services. As Ireland has specifically trained nurses in intellectual disability, it has a prime opportunity to address the health needs and concerns of people with intdisability and actively advocate for how services develop and responds to the changing health needs of ageing people with intellectual disability. [ABSTRACT FROM AUTHOR]

Sarcopenia is defined as a syndrome characterised by progressive and generalised loss of skeletal muscle mass and strength. It has hardly been studied in older people with intellectual disabilities (ID). In this study 884 persons with borderline to profound ID aged 50 years and over, were investigated to determine the prevalence of sarcopenia in this group. To identify the associations of sarcopenia, logistic regression analyses were performed with patient characteristics, mobility, physical activity, intake of energy and proteins, body mass index (BMI) and levels of CRP, albumin and vitamin D in serum. The prevalence of sarcopenia was 14.3% in the total group. In the age group 50–64 years prevalence was 12.7%. Sarcopenia was positively associated with mobility impairment and inflammation and negatively with BMI. The next thing to do is collecting longitudinal data to study the relation between sarcopenia and negative outcomes in older people with ID. [Copyright &y& Elsevier]

The purpose of this study was to examine the effects of physical exercise programs on individuals with intellectual disabilities (ID). This meta-analysis analyzed 67 effect sizes and 14 studies and calculated the standardized mean difference in effect size. The unit of analysis for overall effects was the study, and the sub-group analysis focused on effect size using a random effects model. The effect size of exercise programs was positive with a 0.41 standard deviation. The professional/scholastic measure was the most effective program, whereas the biometric and body composition effects were trivial. This study showed that short-duration exercise programs were more effective than those of longer duration, and an exercise program that runs 4 times per week had a better effect than one that runs 3 times per week. The most effective length of session for exercise was 31–60min, and exercise was more effective for older people than for younger people. Amidst a growing variety of studies of physical exercise programs for individuals with ID, this meta-analysis indicated the present status and future direction of studies on physical exercise programs for individuals with ID. The limitations and implications for practice and theory were discussed. [Copyright &y& Elsevier]

Hypertension, diabetes, hypercholesterolemia and the metabolic syndrome are important risk factors for cardiovascular disease (CVD). In older people with intellectual disability (ID), CVD is a substantial morbidity risk. The aims of the present study, which was part of the Healthy Ageing in Intellectual Disability (HA-ID) study, were (1) to determine the prevalence of CVD risk factors in older people with ID and to compare this with the prevalence in the same-aged general population, (2) to determine how many risk factors had not been previously diagnosed, and (3) to identify correlates of CVD risk factors (gender, age, level of ID, Down syndrome, independent living, activities of daily living, mobility, instrumental activities of daily living, physical activity, use of atypical antipsychotics, central obesity), using logistic regression analyses. In this cross-sectional study, 980 people with borderline to profound ID participated. Hypertension (53%), diabetes (14%) and metabolic syndrome (45%) were present similarly as in the general Dutch population. Hypercholesterolemia was present less often (23%). Fifty percent of the people with hypertension had not been previously diagnosed with this condition. Percentages for diabetes, hypercholesterolemia, and the metabolic syndrome were 45, 46 and 94 respectively. People who were more at risk for CVD risk factors were women, older people, people with obesity, people who lived more independently and people who were able to do groceries or prepare a meal independently. Policy on prevention, detection and treatment of CVD risk factors is urgently needed. [Copyright &y& Elsevier]

Background The aim of this study was to explore the current status of end-of-life care and dying of people with intellectual disability based on the experiences of staff in community living services. Materials and Methods Focus groups and individual interviews were conducted, guided by grounded theory methodology. Results The current status of end-of-life care and dying comprised five key 'issues': knowledge of dying, ethical values, the where of caring, the how of caring and post-death caring. These issues occurred in relationship with 'partners', including the dying person, other clients, fellow staff, family, external health services and the coroner. Conclusions End-of-life care represents a complex interaction between the care issues and the partners involved in care. Despite this complexity, staff were committed to the provision of end-of-life care. [ABSTRACT FROM AUTHOR]

This study aims to analyze the ambulatory visit frequency and medical expenditures of the general elderly population versus the elderly with intellectual disabilities in Taiwan, while examining the effects of age, gender, urbanization and copayment status on ambulatory utilization. A cross-sectional study was conducted to analyze data from 103,183 national health insurance claimants aged 65 or older. A total of 1469 had a principal diagnosis of mental retardation (intellectual disability) and claimed medical outpatient services in 2007. The average number of ambulatory visits was 30.1±23.1, which is much higher than in the United States and other developed countries, and the mean annual visits of the elderly with intellectual disabilities was significantly higher than the general population in Taiwan (35.2±28.7 vs. 30.0±23.1). Age and copayment status affected outpatient visit frequency. The mean medical expenditure per visit and the mean annual outpatient cost were 1146.5±4497.7 NT$ and 34,533.7±115,891.7 NT$, respectively. Male beneficiaries tended to have higher average annual medical expenses and mean medical expenses per visit than female beneficiaries. The three most frequent principal diagnoses at ambulatory visits were circulatory system diseases, musculoskeletal system and connective tissue diseases and digestive system diseases. We conclude that the elderly with intellectual disabilities had higher demand than the general population for healthcare services, and the NHI program lowers the barrier to care for populations with special needs. [Copyright &y& Elsevier]

Physical fitness is as important to aging adults with ID as in the general population, but to date, the physical fitness levels of this group are unknown. Comfortable walking speed, muscle strength (grip strength), muscle endurance (30s Chair stand) and cardiorespiratory endurance (10m incremental shuttle walking test) were tested in a sample of 1050 older adults with ID, and results were compared with reference values from the general population. Across all age ranges, approximately two-third of the entire study population scored ‘below average’ or ‘impaired’. Even the youngest age groups (50–59 or 50–54 years) in this sample achieve similar or worse results than age groups 20–30 years older in the general population. Low physical fitness levels in older adults with ID demonstrate that this group is prone to unnecessary premature loss of functioning and health problems, and maintaining physical fitness should have priority in practice and policy. [Copyright &y& Elsevier]

The increasing population of older people with learning disabilities may lead to higher demand for contact with registered nurses. To date, little research has been undertaken regarding the role of registered nurses in meeting the health and care needs of this client group. In this article, the author reports on the second stage of a three-stage research study that used six case studies to explore this issue. Implications for nursing were identified in areas such as health needs, record keeping, medication, advocacy, social aspects, ageing in place, percutaneous endoscopic gastrostomy (PEG) feeding, spirituality and end-of-life care. The author concludes that registered nurses will need to continue to remain up to date to meet the complex needs of older individuals with learning disabilities. [ABSTRACT FROM AUTHOR]

This study measures physical activity levels in a representative population-based sample of older adults (aged ≥50 years) with intellectual disabilities. For this, the steps/day of all 1050 participants of the Healthy Ageing and Intellectual Disabilities study (HA-ID; a study conducted among three Dutch healthcare providers in 2009–2010), were measured with a pedometer. Largely due to physical limitations (n =103), walking speed <3.2km/h (n =252), limited understanding or non-cooperation (n =233), only 257 of the group were able to participate in valid measurements with pedometers. Of these 257 participants, only 16.7% (95% CI 12.2–21.3) complied with the guideline of 10,000steps/day, 36.2% (95% CI 30.3–42.1) took 7500steps/day or more, and 39% (95% CI 32.6–44.5) was sedentary (<5000steps/day). Because the measured sample was the more functionally able part of the total sample, this result is likely to be a considerable overestimation of the actual physical activity levels in this population. This realistic study shows that physical activity levels are extremely low in adults aged 50 years and over with intellectual disabilities. Focus on lifetime promotion of physical activity in this specific, but rapidly growing population, is recommended. [Copyright &y& Elsevier]

Overweight and obesity are major health problems associated with increased cardiovascular disease risk, which is not sufficiently studied in people with intellectual disability yet. The present study was part of the Healthy Ageing in Intellectual Disability (HA-ID) study. The aim of this study was to establish (1) the prevalence of overweight, obesity and body fat percentage in older people with intellectual disability (ID) through measurement of Body Mass Index (BMI), waist circumference, waist-to-hip ratio (WHR) and skin fold thickness, and compare this with prevalence of overweight and obesity in the general population, and (2) the association of overweight and obesity with participant and treatment characteristics (gender, age, level of ID, Down syndrome, autism, independent living, smoking, (instrumental) activities of daily living ((I)ADL), physical activity and use of atypical antipsychotic medication) using regression analyses. In this cross-sectional study 945 persons, aged 50 and over with borderline to profound ID, living in central settings, in community settings and independently were included. Overweight and obesity were highly prevalent, with more obesity (26%) than in the general Dutch older population (10%) as measured by BMI, and 46–48% obesity as measured by waist circumference and WHR respectively. Women, people with Down syndrome, higher age, less severe ID, autism, people who are able to eat independently, preparing meals and doing groceries independently, people with physical inactivity and use of atypical antipsychotics were significantly more at risk of being overweight or obese. This merits specific actions by policy makers and clinical practice to improve health outcomes. [Copyright &y& Elsevier]

Abstract: Daily living skills are important to ageing adults with intellectual disabilities (ID). The purpose of this study was to investigate the level of these skills in older adults with ID and to investigate the influence of gender, age, level of ID and mobility on these skills. Daily living skills were measured with the Barthel Index (for Activities of Daily Living, ADL) and the Lawton IADL scale (for Instrumental Activities of Daily Living, IADL) in 989 adults with ID aged 50 years and over living in community-based and institutional settings. Descriptives were presented by categories of gender, age, level of ID and mobility. Regression analysis was used to investigate the influence of these variables on total and item scores of ADL and IADL questionnaires. ADL and IADL scores in older adults with ID are comparable to those of vulnerable patient groups. Total ADL score was mainly determined by mobility, while total IADL score was mainly determined by level of ID. Of all 18 separate items of these questionnaires, 11 were determined more by mobility than level of ID. The Barthel Index and Lawton IADL scale are recommended for future use in research and clinical practice in this group. This study stresses the need to support mobility older adults with ID as much as possible, in order to optimalize independency in this group. [Copyright &y& Elsevier]

Purpose - The purpose of this paper is to provide an update on the effectiveness of psychotherapy with persons with intellectual disabilities.Design/methodology/approach - This paper focused on summarizing the conclusions of other reviews published in the last ten years, including a recent review by the authors.Findings - The paper concludes that there is evidence that psychotherapy with persons with intellectual disabilities is at least moderately effective. Further, there is evidence of effectiveness of psychotherapy for both child and adolescent, and adult populations. There is also evidence that a range of therapeutic interventions are effective and that a spectrum of problems can be addressed via psychotherapy.Research limitations/implications - This area has received relatively little attention in the research literature and the area lacks a large base of methodologically sound and rigorous studies. There is a need for well-designed studies, particularly randomized controlled trials (RCTs), and a need for better specification of treatments (e.g. manualized), better outcome measures, and clearer specification of diagnostic categories within the intellectual disability population.Practical implications - This review provides continued support for the use of psychotherapy with persons with intellectual disabilities.Originality/value - This review appears to represent the most current overview of research in this area. [ABSTRACT FROM AUTHOR]

Damage to the hemispheric white matter is observed both in multiple sclerosis (MS) and normal aging, causing neuropsychological deficits in tasks of executive function, working memory (WM), and speed of information processing (SPEED). In this study two main hypotheses were investigated: (a) that SPEED may constitute a determining factor of WM impairment in MS patients and in aging individuals; (b) that self-reported depressive symptoms may aggravate cognitive deficits in MS patients. The study investigated 31 elderly MS patients without depression, 36 depressed ones, 108 demographically comparable controls and 100 community recruited senior participants. Performance of the groups was compared on a self-report measure of depression and on a WM test battery. Results showed that WM performance depends on SPEED, depressive symptoms, age, and schooling - variables which interact in complex ways. [ABSTRACT FROM AUTHOR]

The paper reflects on the significance of artistic practice with older adults in residential care settings, asking what 'home' means to residents living with dementia. To consider how cultural stereotypes of ageing as narratives of loss and decline might be challenged, this paper draws on a recent production On Ageing that was staged at the Young Vic Theatre in London. This play dramatised gerontologist Tom Kirkwood's view that ageing is not a process of deterioration but accumulation, which determines how the body ages physically. Socially, we also accumulate 'stuff' as we grow older and home is often defined by the emotional significance of possessions. So what happens when, in old age, people's physical space shrinks?.The research draws on the principles of person-centred care and non-humanist theories of materiality to debate how home is constructed through the imagination and in the material, spatial and temporal practices of everyday life. In considering how and why creative activity with older adults can help to change a residential care home from an institution to a domestic space, it suggests that the arts have a significant role to play in end of life care. [ABSTRACT FROM AUTHOR]

Hoarding interventions with older adults require significant resources from multiple public agencies, yet recidivism occurs frequently. To improve services through better coordination, some communities have formed multiagency hoarding teams (MAHT), which include aging services. MAHTs requested this mixed methods study to understand the progression of cases through the public sector. Quantitative data collected on 52 cases involving adults ages 60+ identified steps in this process. Qualitative data collected from MAHT members were the basis for case studies illustrating the progression of cases through the public sector. Findings have implications for social workers involved in local service coordination, training, and policy. [ABSTRACT FROM AUTHOR]

Aim: This study explored the effect of internal adaptation and external resources to psychological well-being for the disabled elderly. Methods: Data were collected by face-to-face interviews with physically disabled elderly people, including the institutional and community-based long-term care service users in middle Taiwan. The number of persons interviewed was 563, of whom 505 completed the survey and met the disability criteria. Path analysis was applied. Internal resources (coping strategies and self-management of health) and external resources (social support and environmental support) were hypothesized to be related to difficulty in adapting to disability, and had a further impact on depressive symptoms and life satisfaction. Results: Acceptance-action coping strategies were beneficial in the adaptation process and in psychological well-being, and self-management of health was positively related to successful adaptation. Social support and environmental support were beneficial to adaptation and psychological well-being, although the effects were modest. In general, the effect of internal resources was larger than the external resources to adaptation and psychological well-being. Conclusion: Positive coping and self-management as well as the use of external resources are positive indicators of successful adaptation to disability. The disabled elderly should be encouraged to take a positive attitude toward disability, and external resources should also be built up to support them. [ABSTRACT FROM AUTHOR]