Medical aspects of ageing in a population with intellectual disability: I. Visual impairment

Abstract

Visual function of an institutionalized population with intellectual disability, consisting of 70 subjects with a mean age of 70.1 (range 60-92) years at initial evaluation, was assessed during a 10-year prospective longitudinal study. One subject had Down's syndrome and could not be assessed as a result of dementia. Lower visual acuity values were relatively overrepresented as compared to reported data from ageing populations without intellectual disability. In addition, the prevalence of moderate to severe visual impairment was distinctly higher (27.9% in the group studied vs. 0.66% at age 60-69 years to 13% over age 80 in a population without intellectual disability). During follow-up, visual function improved in three out of 61 subjects (4.9%) after cataract surgery, and deteriorated in eight out of 61 subjects (13.1%), even with optimal correction, as a result of cataract and macular degeneration. Causes of excess impairment were congenital or childhood conditions, too-late diagnosis of glaucoma and suboptimal correction of refractive errors in non-cooperative individuals. The present author concludes that it should be possible to reduce excess impairment by an active diagnostic and therapeutic attitude to subjects from a young age onwards.

Elderly Persons with Intellectual Disability: A Study of Clinical Characteristics, Functional Status, and Sensory Capacity

“…Such conditions include moderate to severe hearing loss and visual impairment [8,9], a high incidence of balance and gait dysfunction [10], arthritis and urinary incontinence [11], obesity [12], and nonischemic heart disorders [13]. Determination of premature aging may be indicated by a range of signs and symptoms [14].…”

Vision and oral health needs of individuals with intellectual disability

“…In addition, the prevalence of cataracts, which tends to increase with age in the general population, increases to a greater extent with age for individuals with Down syndrome [Jacobson, 1988]. Prevalence estimates of cataracts among individuals with Down syndrome has been found to range from 5 to 85% compared with 1 to 58% in the general population and 3 to 69% in the overall population of individuals with ID [Cullen and Butler, 1963;Lyle et al, 1972;Jaeger, 1980;NCHS, 1983;Levy, 1984;Shapiro and France, 1985;Jacobson, 1988;Caputo et al, 1989;Aitchison et al, 1990;Catalano, 1990;Cooley and Graham, 1991;Hestnes et al, 1991;Sacks et al, 1991;Pérez-Carpinell et al, 1994;Prasher, 1994;Roizen et al, 1994;Evenhuis, 1995;Berk et al, 1996;da Cunha and Moreira, 1996;McCulloch et al, 1996;van Allen et al, 1999;Merrick and Koslowe, 2001;Warburg, 2001b;Friedman et al, 2002;Congdon et al, 2003;Kerr et al, 2003;Kleinstein et al, 2003;The Eye Diseases, 2004b;van Splunder et al, 2004;Gormezano and Kaminski, 2005;Murphy et al, 2005]. Likewise, the prevalence of keratoconus has been reported to be between 3 and 30% among individuals with Down syndrome compared with Ͻ1% in the general population and 1 to 19% in the overall population of individuals with ID [Cullen and Butler, 1963;Lyle et al, 1972;…”

“…For example, while the percentage of lens anomaly reported for adults without ID has been reported to be as low as 1% [Kleinstein, 1984], Sacks et al [1991] found that 7% of adults with ID working in an activity center in the United States had cataracts. British administrative data suggest prevalence estimates of cataracts as high as 28% among individuals with ID [Kerr et al, 2003], while a study of individuals with ID 60 years of age and older found that 69% had cataracts [Evenhuis, 1995]. Similarly, prevalence estimates of keratoconus are higher among individuals with ID compared to the general population (1 to 19% versus Ͻ 1%, respectively), with the condition reported to be more common among males than females with ID [Levy, 1984;Kennedy et al, 1986;Jacobson, 1988;Hestnes et al, 1991;Maino et al, 1996;McCulloch et al, 1996;Warburg, 2001b;van Splunder et al, 2004].…”

“…The article concludes with recommendations to improve the vision and oral health of individuals with between the ages of 45 and 64 years and 7% of those over 65 years in the general U.S. population have been reported to have vision problems, Kapell et al [1998], studying New York residents, found that 9 to 16% of 45 to 64 year olds with ID and 17 to 50% of 65 to 74 year olds with ID had vision problems. Other studies have reported that 18 to 99% of 50ϩ year olds with ID have vision problems [Day, 1987, Moss, 1991Evenhuis, 1995;van Schrojenstein Lantman-de Valk et al, 1997;Janicki and Dalton, 1998;Evenhuis et al, 2001b;Warburg, 2001b;Janicki et al, 2002;Kerr et al, 2003;van Splunder et al, 2003avan Splunder et al, , 2004.…”

“…Similarly, while the overall population prevalence of strabismus outside the United States ranges from Ͻ1 to 10%, international researchers found the prevalence of strabismus among individuals with ID to range from 4 to 45% (Table 1) [Lyle et al, 1972;Bankes, 1974;Woodruff, 1977;Woodruff et al, 1980;Levy, 1984;Jacobson, 1988;Aitchison et al, 1990;Hestnes et al, 1991;McCulloch et al, 1996;Buch et al, 2001;van Splunder et al, 2003avan Splunder et al, , 2003bvan Splunder et al, , 2004Woodhouse et al, 2003]. The prevalence of cataracts (opacity of the lens of the eye, the capsule, or both) and keratoconus (swelling and scarring of the cornea) among individuals with ID also has been reported to be much higher than that in the general population (Table 1) [Lawson and Schoofs, 1971;Bankes, 1974;Markovits, 1975;Woodruff, 1977;Jaeger, 1980;NCHS, 1983;Levy, 1984;Kennedy et al, 1986;Day, 1987;Jacobson, 1988;Aitchison et al, 1990;Hestnes et al, 1991;Sacks et al, 1991;Evenhuis, 1995;Maino et al, 1996;McCulloch et al, 1996;Warburg, 2001b;Friedman et al, 2002;Congdon et al, 2003;Foran et al, 2003;Kerr et al, 2003;…”