AGING AND INTELLECTUAL DISABILITY

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AGING AND INTELLECTUAL DISABILITY

  1. 1. AGING AND INTELLECTUAL DISABILITY<br />Dr Nashareen Morris<br />20 October 2009<br />
  2. 2. AIMS<br />Aimed at caregivers of PWID<br />Primary healthcare<br />Physical health of PWID<br />Preventative measures<br />
  3. 3. OVERVIEW<br />Background – why<br />Causes of morbidity<br />Disease specific mortality<br />Special health needs of PWID<br />Literature and studies overseas<br />Meeting health needs of PWID<br />
  4. 4. BACKGROUND<br />Life expectancy – Down syndrome<br />1983 : 25yrs<br />1997 : 49yrs<br />Average LE currently approx 66yrs<br />Less than general population<br />Future ? Equal to non –ID population (76,9 yrs)<br />New geriatric population<br />
  5. 5. BACKGROUND (cont.)<br />Barriers to adequate healthcare<br />Communication<br />Anxiety<br />Do not recognise significance of symptoms<br />Deficits in service provision (lack of resources,<br />Lack of trained staff, continuity of care, diagnostic overshadowing)<br />Healthcare inequality –SA vs developed countries<br />
  6. 6. TRENDS IN HEALTHCARE FOR PWID<br />Traditional approach :<br />Palliative care<br />Custodial care<br />Concept of ‘illness’ and ID<br />Current thinking :<br />Preventative<br />Participative<br />Health defined as state of emotional, social and mental well-being and it’s reciprocal relationship with physical well-being<br />
  7. 7. MORBIDITY<br />Present earlier than general population<br />Atypical presentation (challenging behaviour, loss of skills)<br />More specific health problems<br />More often multiple chronic physical illnesses (approx 5 medical conditions on average)<br />Diagnosis and treatment more complicated<br />Est 50% of health problems undiagnosed<br />Different patterns of morbidity<br />Longer recovery time<br />More hospitalisations ( ?SA)<br />Excess in mortality when compared to general population<br />Rapid deterioration if untreated with more complications<br />
  8. 8. EYES<br />Down syndrome : ocular changes > 35yrs<br />50 – 59 yrs 33% mod to severe visual loss<br />Cataracts, corneal abnormalities, refractive errors, nystagmus more common<br />More severe ID – higher prevalence of visual impairment<br />
  9. 9. EARS<br />Non –ID population – 25% 65-74 yrs<br /> -50% > 85 yrs<br />Down syndrome may experience hearing loss from age 50<br />Impacted earwax – tinnitus, may mimic dementia in person with Down syndrome<br />
  10. 10. ORAL HEALTH<br />Higher incidence of caries and periodontal disease<br />Contributes to eating, speech, sleep, pain<br />Extractions – under GA<br />Limited access to adequate and appropriate dental care<br />NEEDS DENTAL EXAMINATIONS THROUGHOUT LIFETIME<br />
  11. 11. THYRIOD<br />Very seldom routinely checked <br />Higher prevalence esp in Down syndrome<br />
  12. 12. Cardiovascular<br />Added risk factors – anti-psychotics and dyslipidaemias<br />Obesity and sedentary lifestyle<br />Family history<br />Metabolic syndrome<br />Not routinely screened or followed up<br />
  13. 13. Bone Health<br />Osteoporosis esp problematic in severe and profound ID<br />Average age of 1st fracture 42yrs<br />Appendages eg fingers,toes<br />HRT not given routinely<br />Low levels of vit D despite Ca-supplementation<br />Effect of AED, anti-hypertensives (Beta-blockers), injectable contraceptives<br />Effect on quality of life after fracture<br />
  14. 14. RESPIRATORY<br />Risk of respiratory illness at least 3 x higher –lifetime risk<br />Pneumonia <br />Tuberculosis in SA context<br />Chronic obstructive lung disease linked to smoking<br />Respiratory illness accumalative effect with aging<br />
  15. 15. Gastro-intestinal<br />Peptic ulcer disease – mild/moderate ID<br />Intestinal obstruction – severe/profound ID<br />Constipation – link with colon cancer<br />
  16. 16. OTHER<br />Prostate problems – BPH, incontinence<br />Cancer of the cervix – sexually active females, ?less than general population<br />Dementia – Down syndrome approx 10yrs earlier, Alzheimer<br />Menopause (DS)– earlier than general population <br />
  17. 17. MORTALITY<br />Excess disease specific mortality < 30 yrs<br />Healthy survivor effect<br />Main causes of mortality: -Vascular disease e.g. strokes,<br /> heart attacks<br /> -Respiratory illness - pneumonia<br /> -Fatal fractures<br /> -Malignancy<br /> - Dementia<br />
  18. 18. Recommendations<br />Vaccination – hepatitis B, Pneumovax, Influenza<br />Health checking (structured physical exam and questionnaire at regular intervals – pref annually)<br />Exclude physical illness when change in baseline functioning noticed<br />

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