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Elderly Adults with Dementia and Young Adults with Developmental Disabilities: Internist Perspectives on Similarities and Differences in Care 4_24_13 Sophia Jan

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Elderly Adults with Dementia and Young Adults with Developmental Disabilities: Internist Perspectives on Similarities and Differences in Care 4_24_13 Sophia Jan

  1. 1. Elderly adults with dementia and young adults with developmentaldisabilities: Internist perspectives on similarities and differences in careSophia Jan, MD, MSHP1,2,3,4, Dava E. Szalda, MD1, Manuel E Jimenez, MD, MSHP1,3,41Department of Pediatrics, 2Department of Medicine, 3Leonard Davis Institute of Health Economics, 4CHOP PolicyLab, University ofPennsylvania School of MedicineBackground Results Conclusions  Twenty-one practicing physicians in 4 different states (PA, NJ, DE, DC) in both academic and private  Most internists found more similarities than One in 6 children has an intellectual or differences when describing care for young practices were interviewed. developmental disability (I/DD). adults with intellectual and developmental Concurrently, the lifespan of people with I/DD Table 1: Major similarities between elderly patients with dementia and young adults with intellectual or disabilities (I/DD) and elderly adults with is rapidly approaching the mean lifespan of developmental disabilities dementia. the general population. Themes and Quotes  Young adults with I/DD and elderly adults with Many of adults with I/DD share similar dementia share similar needs for office Similar assessments requiring longer office visits and staffing resources functional needs limitations and caregiver “There are certain health maintenance issues that are going to be common to both, guardianship, wandering, supports, caregiver services and community dependencies as elderly patients with falls, medication reconciliation, home safety, assessing for depression in both groups. Both are going to need supports. dementia more time for an office visit, more staff time after an office visit.”  Nearly all major similarities, including need for Difficulty obtaining medical records and coordinating care longer office visits, expanded staffingObjectives “I think that they generally both have lots of medications and lots of specialists when theyre extremely resources, care coordination, case complicated and trying to navigate all that....in both of scenarios it may be hard to get documentation from management, and reliance on community Examine how clinical needs and practice their specialists, in particular, the mental health specialists.” services, are those also described by safety net supports by internists caring for young adults Importance of an advocate providers. with developmental disabilities may be similar “[Due to] the dependency. You need someone else to actually be the medical advocate.” or different from that of elderly patients with Reliance on community services and agencies for transportation and supervision dementia. “The transportation is a huge issue and it tends to be for both of our groups.” “We definitely do use...similar skilled nursing facilities or supervision nursing.” Impact of insurance lapses or changes Policy ImplicationsMethods “I get people who transfer into my practice because they were getting fairly intense medical care and then they lose insurance. So in a lot of ways Im getting transitional patients later in life. And I need to resume care  Current geriatric interdisciplinary care models We conducted semi-structured interviews with for them.” could potentially serve the needs of adults a convenience sample of 21 internal medicine with intellectual or developmental disabilities physicians Table 2: Major differences between elderly patients with dementia and young adults with intellectual or developmental disabilities (I/DD), especially when addressing supervision We sampled participants based on known or and caretaker needs. reported experience with young adults with Themes and Quotes  Strengthening health care safety net pediatric onset chronic illness using snowball Prevalence and presentation of specific diseases infrastructure and services will not only strategy “Obviously there are different diseases, so they differ in support. So for example, for the older adult patient I’m facilitate care for low-income families, but also We recorded, transcribed, and coded interviews more worried about blood pressure and heart disease and diabetes, where the younger patient I’m more for the growing numbers of elderly patients until thematic saturation worried about fertility and making sure they don’t get an STD.” with dementia and adult patients with I/DD. We identified themes using modified grounded Type of life stressors and community supports needed theory “Students or young adults are more interested in colleges and learning and that kind of social support, where the older adult patient are more interested in their job and keeping it.”

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