1. Elderly adults with dementia and young adults with developmental
disabilities: Internist perspectives on similarities and differences in care
Sophia Jan, MD, MSHP1,2,3,4, Dava E. Szalda, MD1, Manuel E Jimenez, MD, MSHP1,3,4
1Department of Pediatrics, 2Department of Medicine, 3Leonard Davis Institute of Health Economics, 4CHOP PolicyLab, University of
Pennsylvania School of Medicine
Background 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 staffing
Objectives “I think that they generally both have lots of medications and lots of specialists when they're 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 Implications
Methods “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 I'm 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.”