Multimorbidity in older adults with intellectual disabilities

Hermans, Heidi; Evenhuis, Heleen M.

doi:10.1016/j.ridd.2014.01.022

Cited by 160 publications

(167 citation statements)

References 46 publications

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“…This makes any direct comparison difficult; however, the relative doubling of multimorbidity (defined as two or more conditions) between adults with and adults without ID in the Scottish study 92 were similar to our findings, in which adults with ID were 1.8 times more likely to have multiple QOF conditions. The Dutch study finding of greater multimorbidity among adults with Down syndrome 91 was the opposite of what we found, presumably owing to this study involving older adults only (≥ 50 years), whereas our patients with Down syndrome were primarily younger (73% were < 50 years old).…”

Section: Disease Prevalencecontrasting

confidence: 99%

“…19,20,83,[88][89][90][91][92] These have shown high levels of comorbidity, although direct comparisons of estimated prevalence with the general population has generally been difficult owing to population selection and disease definition. Only a recent Scottish study in primary care of 8014 adults with ID has been able to provide comprehensive standardised prevalence rates by age groups, 92 and produced findings for 2007 similar to our own published findings for 2012.…”

Section: Disease Prevalencementioning

confidence: 99%

“…Only a recent Scottish study in primary care of 8014 adults with ID has been able to provide comprehensive standardised prevalence rates by age groups, 92 and produced findings for 2007 similar to our own published findings for 2012. 66 In addition, the recent studies in Scotland, 92 Ireland 83 and the Netherlands 91 have all considered multimorbidity in adults with ID. These studies considered a wider range of conditions than our study and, as a result, reported higher levels of multimorbidity than we did.…”

Section: Disease Prevalencementioning

confidence: 99%

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An evaluation of the effectiveness of annual health checks and quality of health care for adults with intellectual disability: an observational study using a primary care database

Carey

Hosking

Harris

et al. 2017

Health Serv Deliv Res

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Background People with intellectual disability (ID) have poorer health than the general population; however, there is a lack of comprehensive national data describing their health-care needs and utilisation. Annual health checks for adults with ID have been incentivised through primary care since 2009, but only half of those eligible for such a health check receive one. It is unclear what impact health checks have had on important health outcomes, such as emergency hospitalisation. Objectives To evaluate whether or not annual health checks for adults with ID have reduced emergency hospitalisation, and to describe health, health care and mortality for adults with ID. Design A retrospective matched cohort study using primary care data linked to national hospital admissions and mortality data sets. Setting A total of 451 English general practices contributing data to Clinical Practice Research Datalink (CPRD). Participants A total of 21,859 adults with ID compared with 152,846 age-, gender- and practice-matched controls without ID registered during 2009–13. Interventions None. Main outcome measures Emergency hospital admissions. Other outcomes – preventable admissions for ambulatory care sensitive conditions, and mortality. Data sources CPRD, Hospital Episodes Statistics and Office for National Statistics. Results Compared with the general population, adults with ID had higher levels of recorded comorbidity and were more likely to consult in primary care. However, they were less likely to have long doctor consultations, and had lower continuity of care. They had higher mortality rates [hazard ratio (HR) 3.6, 95% confidence interval (CI) 3.3 to 3.9], with 37.0% of deaths classified as being amenable to health-care intervention (HR 5.9, 95% CI 5.1 to 6.8). They were more likely to have emergency hospital admissions [incidence rate ratio (IRR) 2.82, 95% CI 2.66 to 2.98], with 33.7% deemed preventable compared with 17.3% in controls (IRR 5.62, 95% CI 5.14 to 6.13). Health checks for adults with ID had no effect on overall emergency admissions compared with controls (IRR 0.96, 95% CI 0.87 to 1.07), although there was a relative reduction in emergency admissions for ambulatory care-sensitive conditions (IRR 0.82, 95% CI 0.69 to 0.99). Practices with high health check participation also showed a relative fall in preventable emergency admissions for their patients with ID, compared with practices with minimal participation (IRR 0.73, 95% CI 0.57 to 0.95). There were large variations in the health check-related content that was recorded on electronic records. Limitations Patients with milder ID not known to health services were not identified. We could not comment on the quality of health checks. Conclusions Compared with the general population, adults with ID have more chronic diseases and greater primary and secondary care utilisation. With more than one-third of deaths potentially amenable to health-care interventions, improvements in access to, and quality of, health care are required. In primary care, better continuity of care and longer appointment times are important examples that we identified. Although annual health checks can also improve access, not every eligible adult with ID receives one, and health check content varies by practice. Health checks had no impact on overall emergency admissions, but they appeared influential in reducing preventable emergency admissions. Future work No formal cost-effectiveness analysis of annual health checks was performed, but this could be attempted in relation to our estimates of a reduction in preventable emergency admissions. Funding The National Institute for Health Research Health Services and Delivery Research programme.

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Section: Disease Prevalencecontrasting

confidence: 99%

Section: Disease Prevalencementioning

confidence: 99%

Section: Disease Prevalencementioning

confidence: 99%

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An evaluation of the effectiveness of annual health checks and quality of health care for adults with intellectual disability: an observational study using a primary care database

Carey

Hosking

Harris

et al. 2017

Health Serv Deliv Res

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“…8,20,21 Moreover, multimorbidity has been positively associated with age, with the severity of the IDD and with the presence of Down's syndrome. 22 Persons with severe and profound levels of IDD have a higher overall risk of developing health problems and medical complications, as well as a high prevalence of sensory impairments, and most of them require long-term pharmacological treatments. [23][24][25] As they age, the risk of health problems increases and their life expectancy drops as the severity of the intellectual disability increases.…”

Section: Health In Intellectual Developmental Disordersmentioning

confidence: 99%

Health profiles in people with intellectual developmental disorders

et al. 2017

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Objective. To better understand the health profiles of people with intellectual disability (ID), focusing on the variables that are associated with a poorer health status. Materials and methods. Data were collected from the Survey on Disability, Personal Autonomy and Dependency (EDAD 2008) of the Spanish National Statistics Institute (INE). The health data of 2 840 subjects with IDD were analyzed in order to verify the impact of different variables on their health profiles. Results. People with severe and profound levels of IDD presented a higher number of medical diagnoses. At residence centers there was a larger proportion of individuals with a higher prevalence of chronic diseases and more severe conditions; age also was an important factor. Conclusion. The health profiles of individuals with IDD differ depending on the severity level of their IDD and their degree of institutionalization. Further research is needed to provide better health care for people with IDD.

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“…Así, diversos autores (Glasson et al, 2014;Hermans y Evenhuis, 2014) señalan que las personas con SD son más propensas a desarrollar la demencia tipo Alzheimer, especialmente a partir de los 35 años, siendo el foco principal en este campo de la investigación la asociación entre los determinantes genéticos, los marcadores biológicos y las limitaciones en el funcionamiento de dominios cognitivos específicos (Tyrrell et al, 2001).…”

Section: Introductionunclassified

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

Pérez

Gómez

Rodríguez

2016

Redis

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Existe una estrecha relación entre el síndrome de Down y la enfermedad de Alzheimer. Diversos factores de riesgo influyen en esta relación, en la que la evaluación de la demencia es difícil debido a la falta de instrumentos y tratamientos específicos. Se realizó una búsqueda de los años comprendidos entre 2005-2015 en diferentes bases de datos. Se identificaron diversos factores de riesgo (genéticos, ambientales, cognitivos) y se encontraron varios instrumentos de evaluación, poco adecuados y/o con debilidades psicométricas. Los tratamientos existentes son escasos y, casi exclusivamente, farmacológicos. Se discute acerca de la importancia de llevar a cabo estudios sistemáticos sobre los factores de riesgo para la prevención de la enfermedad de Alzheimer en personas con síndrome de Down, así como la necesidad de un protocolo de evaluación específico y adaptado que permita implementar tratamientos más específicos y efectivos.

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Multimorbidity in older adults with intellectual disabilities

Cited by 160 publications

References 46 publications

An evaluation of the effectiveness of annual health checks and quality of health care for adults with intellectual disability: an observational study using a primary care database

An evaluation of the effectiveness of annual health checks and quality of health care for adults with intellectual disability: an observational study using a primary care database

Health profiles in people with intellectual developmental disorders

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

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