Impact of Dementia‐derived Nonpharmacological Intervention Procedures on Cognition and Behavior in Older Adults With Intellectual Disabilities: A 3‐year Follow‐up Study

Abstract

Dementia appears at a higher rate among some adults with intellectual disabilities (ID) and this potentially poses a greater risk of nursing home admission. Yet, to date, there is no evidence on the efficacy of general dementia-derived environment-, personnel-, and patient-oriented intervention strategies in delaying onset of dementia or in slowing down its rate of progression in this population. To investigate the feasibility and efficacy of a multicomponent nonpharmacological approach, the authors studied a sample of 14 adults with worsening cognition and everyday functioning who were no longer manageable by their family or staff in day centers or group homes, and who were relocated in a model special care unit (SCU) designed to proactively accommodate the needs of people with ID and dementia. Baseline level and rate of decline across a 3-year period were assessed by means of the Dementia Questionnaire for Persons with Intellectual Disabilities and compared to two control groups not in dementia-capable programs matched for age, sex, and severity of ID. After 3 years, the authors found some improvement in cognition and stabilization in everyday functioning and behaviors in the SCU residents and a worsening in the control groups. The authors noted that enrollment in a dementia-capable program facilitated daily practice of residents' residual skills and abilities, enhancing their memory and verbal communication, that the prosthetic environment contributed to activity maintenance and appropriate intellectual challenges, and that the greater participation on an individual level added to the skill maintenance. Although the interpretation of these positive findings is not straightforward, they confirm the validity of this "in-place progression" model and provide a platform for continuing progress in person-centered services and care for aging persons with ID.

Síndrome de Down y enfermedad de Alzheimer: factores de riesgo, evaluación e intervención

“…(De Vreese et al, 2012). Aunque, por otra parte, los enfoques conductuales, para tratar algunos de los síntomas de la demencia, también han sido objeto de muchos estudios en las últimas décadas y se han encontrado pocas evidencias de la efectividad de este tipo de tratamientos o, como mínimo, de que sus resultados se mantengan mientras los efectos degenerativos de la enfermedad siguen avanzando (SubiranaMirete et al, 2011).…”

Comorbid Conditions in Individuals with Intellectual Disabilities

“…Environmental modifications attempted include separate spaces for occupational and recreational activities, physiotherapeutic bath, and areas for relaxation and other activities (De Vreese et al 2012). The importance of adequate signage, safety features, welcoming wall colors, floor coverings, air quality, daylight, and soft-indirect lighting are stressed (De Vreese et al 2012). Use of cameras, calming music, and pet therapies are also recommended (De Vreese et al 2012).…”

Prevalence of dementia and organization of dementia care in Swiss disability care homes

“…In care homes for PWID, staff may mainly come from nonmedical, non-nursing background and may therefore lack the specific knowledge and skills for the new challenge which is dementia care, particularly in areas such as pain and symptom management [6]. In order to improve care competencies in these areas, knowledge transfer from non-ID dementia care seems to be a promising approach: a specialised prosthetic environment based on non-ID dementia care principles was found to contribute to maintenance of skills and activities in older PWID, likely by facilitating participation on an individual level and providing appropriate intellectual challenges [7,8]. Consensus recommendations for the evaluation and management of dementia in PWID have recently become available for the United States [9], but there is currently no specific guidance for Switzerland.…”