These results suggest that either a cohort effect is operating (i.e. contemporary populations are healthier than previous populations), or that there may be under-recognition of select risk factors and diseases.

To assist families and organizations in their planning for extended care that accompanies the diagnosis of dementia, the National Task Group on Intellectual Disabilities and Dementia Practices (NTG) in the United States adopted a set of practice guidelines covering the period from when suspicions are aroused to when care ends with eventual death. These guidelines are drawn from the research literature as well as clinical experiences and demonstrated best practices. The guidelines delineate what actions should be undertaken and are presented in a manner that reflects the progressive nature of prevalent dementias. To enable the development of the most appropriate and useful services and care management for adults with intellectual disabilities affected by dementia, the NTG adopted the staging model generally accepted for practice among generic dementia services. The staging model follows the flow from a prediagnosis stage when early recognition of symptoms associated with cognitive decline are recognized through to early, mid, and late stages of dementia, and characterizes the expected changes in behavior and function. In keeping with the National Plan to Address Alzheimer's Disease recommendations for earlier and more widespread efforts to detect possible symptoms, the guidelines cite the application of the NTG-Early Detection Screen for Dementia as a first step in documenting early signs of cognitive and functional changes among people with intellectual disabilities. The guidelines also provide information on nonpharmacological options for providing community care for persons affected by dementia as well as commentary on abuse, financial, managing choice and liability, medication, and nutritional issues.

This new scale when used with objective burden and other scales offers an opportunity to more systematically measure the difficulties staff experience when caring for persons with ID who present with symptoms of AD.

Ethical dilemmas are an integral part of the practitioner's reality and impact upon the quality of care provided to the resident. The establishment of ethical principles aims to guide the worker through difficult scenarios involving morals, values and beliefs. Often, these precepts contradict one another and are strongly bound to the practitioner's and the resident's standpoints. The ethical principles of beneficence and respect for autonomy pose a conflict in judgment regarding an elderly woman's care in an 816-bed long term care facility. The contributing parties to the conflict are the medical staff, social worker and the resident. The ethical dilemma will be analyzed according to the utilitarian and deontological theories. Resolution to the conflict is offered at the conclusion.

A demonstration project was undertaken in the state of New York to assess how area agencies on aging (AAAs) would approach outreach and direct aid to families caring for someone with a developmental disability. It was found that AAAs organized their outreach and direct-aid efforts using three main approaches: direct operation, contract operations, and multi-organizational. They generally organized staff time so that about two days per week of effort was devoted to undertaking outreach activities, conducting community education, and providing casework and referrals for target families. Four major distinctions were identified that differentiated work with older carers of persons with a developmental disability from that with other kinds of carers: complexity of problems presented by households identified, vagaries of fiscal resources, diverse household composition, and planning for eventualities. It was concluded that targeting AAAs for outreach and providing help to these carers was effective and productive and should be replicated throughout the United States.