Looking across health and healthcare outcomes for people with intellectual and developmental disabilities and psychiatric disorders: population-based longitudinal study

Abstract

Background Intellectual and developmental disabilities (IDDs) and psychiatric disorders frequently co-occur. Although each has been associated with negative outcomes, their combined effect has rarely been studied. Aims To examine the likelihood of five negative health and healthcare outcomes for adults with IDD and mental health/addiction disorders (MHAs), both separately and together. For each outcome, demographic, clinical and system-level factors were also examined. Method Linked administrative data-sets were used to identify adults in Ontario, Canada, with IDD and MHA (n = 29 476), IDD-only (n = 35 223) and MHA-only (n = 727 591). Five outcomes (30-day readmission, 30-day repeat ED visit, delayed discharge, long-term care admission and premature mortality) were examined by logistic regression models with generalised estimating equation or survival analyses. For each outcome, crude (disorder groups only) and complete (adding biosocial covariates) models were run using a general population reference group. Results The IDD and MHA group had the highest proportions across outcomes for both crude and complete models. They had the highest adjusted ratios for readmissions (aOR 1.93, 95%CI 1.88–1.99), repeat ED visit (aOR 2.00, 95%CI 1.98–2.02) and long-term care admission (aHR 12.19, 95%CI 10.84–13.71). For delayed discharge, the IDD and MHA and IDD-only groups had similar results (aOR 2.00 (95%CI 1.90–2.11) and 2.21 (95%CI 2.07–2.36). For premature mortality, the adjusted ratios were similar for all groups. Conclusions Poorer outcomes for adults with IDD, particularly those with MHA, suggest a need for a comprehensive, system-wide approach spanning health, disability and social support.

A systematic review of in-patient psychiatric care for people with intellectual disabilities and/or autism: effectiveness, patient safety and experience

“…30 days), which appears to be more likely for people with intellectual disabilities, 42 or the frequency of delayed discharge. 43 …”

“…30 days), which appears to be more likely for people with intellectual disabilities, 42 or the frequency of delayed discharge. 43 Considering discharge, a substantial proportion of in-patients returned to their prior residence when discharged compared with those who moved to live at a new location, [2][3][4]6,14,57,75 which appeared to be associated with a longer length of stay. 101 Those discharged from specialist in-patient services were less likely to be from out of area and more likely to return to live at home.…”

Current Activities Centered on Healthy Living and Recommendations for the Future: A Position Statement from the HL-PIVOT Network

“…Although there were some promising data supporting the transfer of health knowledge to customers, these were not conclusive. 165 Other novel approaches to HL programs in the community are diverse, including: (1) increasing health care access for adults with intellectual and developmental disabilities 166 ; (2) improving access and quality of community mental health services for women in ethnic minority settings; 167 and (3) building an environment which supports increases in PA, 168 among many others. The workplace is another viable setting for HL program implementation in the adult population.…”

Evaluating specialist intensive support teams for adults with intellectual disabilities who display behaviours that challenge: The IST-ID mixed methods study

“…Research suggests that these individuals are subject to unnecessary long-term psychotropic medication use, poorer health, abuse and social exclusion(1,4). International studies indicate that adults with intellectual disabilities are more likely to visit the emergency department for psychiatric issues(5), return to the emergency department within 30 days of discharge(6), be in long-term inpatient care and experience premature mortality(7). Failure to effectively address behaviours that challenge before a crisis arises causes significant distress and burden to families and consequent breakdown of placements(8,9), in addition to significant healthcare and societal costs.…”