Patterns of aging in adults with intellectual disabilities

Changes in health care and increasing provision of community services have resulted in an increased number of community dwelling older adults with intellectual disabilities (ID), leading to questions about future planning for service delivery. Although selected aspects of functioning have been explored in various research studies, less longitudinal information pertaining to broad aspects of health is available to planners. This longitudinal project was designed over 10 years ago with the primary purpose of exploring individual and systemic issues in the health needs of this challenging population, leading to improved service planning.Cross-sectional and longitudinal health data were collected from 360 adults with intellectual disabilities (ID) recruited from social services agencies from across the province of Saskatchewan. Data collection included caregiver information, chart information and directly administered tests of selected aspects of cognitive functioning. Formal data-collection occurred every second year for a maximum of four test times, and was supplemented by follow-up phone calls.Analysis of study results showed that young, rather than older people without DS had a greater severity of health needs related to their underlying conditions, and more problematic behavioral and mental health issues. The reason for this was likely the increased survival of multiply handicapped young people, and the increasing trend for these people to be maintained in the community rather than in large institutions. This population was more likely to receive psychotropic medications, both for underlying problems such as seizure disorders, but also for difficult behaviors such as aggression.On the other hand, adults with DS had relatively fewer problems in their younger adult years, but had increasing problems as they aged. Most aspects of functioning were decreased in the older compared to the younger cohorts, which was consistent with the longitudinal, individual level data showing yearly declines in most measured skills. These declines were greater than those found in adults without DS. Although yearly declines were noted in most age cohorts, the largest declines were noted in the oldest age groups, 50 years and over, suggesting that, while aging related decline was present from an early age, declines severe enough to suggest a dementing process probably do not start until after middle age. Declines in visual memory appear to precede those in praxis.Mortality was increased with age, lower baseline functioning, DS, male gender, and baseline depressive symptoms.The use of aging programs did not change much during the course of the study, but interesting differences in service use between people with and without DS were noted. Adults with DS were more likely than those without DS to participate in generic aging services, which was thought to be due to people with DS presenting with more typical, Alzheimer type behaviors, rather than severe behaviors such as aggression

L’aide médicale à mourir dans les programmes d’études en sciences de la santé : étude exploratoire qualitative

Background: This paper offers insight into (1) the driving and restraining forces impacting the inclusion of medical assistance in dying (MAID) in health sciences curricula, (2) the required resources for teaching MAID, and (3) the current placement of MAID in health sciences curricula in relation to end-of-life care concepts. Method: We conducted a qualitative exploratory study in a Canadian province using Interpretive Description, Force Field Analysis, and Change as Three Steps. We interviewed ten key informants (KI), representing the provincial health sciences programs of medicine, nursing, pharmacy, and social work. KIs held various roles, including curriculum coordinator, associate dean, or lecturing faculty. Data were analyzed via the comparative method using NVivo12. Results:  Curriculum delivery structures, resources, faculty comfort and practice context, and uncertainty of the student scope of practice influenced MAID inclusion. Medical and pharmacy students were consistently exposed to MAID, whereas MAID inclusion in nursing and social work was determined by faculty in consideration with the pre-existing course objectives. The theoretical and legal aspects of MAID were more consistently taught than clinical care when faculty did not have a current practice context. Care pathways, accreditation standards, practice experts, peer-reviewed evidence, and local statistics were identified as the required resources to support student learning. MAID was delivered in conjunction with palliative care and ethics, legalities, and professional regulation courses. Conclusion: The addition of MAID in health sciences curricula is crucial to support students in this new practice context. Identifying the drivers and restrainers influencing the inclusion of MAID in health sciences curricula is critical to support the comprehensiveness of end-of-life education for all students.Contexte : Cet article vise à explorer 1) les forces motrices et restrictives ayant un effet sur l’inclusion de l’aide médicale à mourir (AMM) aux programmes d’études en sciences de la santé, 2) les ressources nécessaires à l’enseignement de l’AMM, et 3) la place actuelle occupée par l’AMM dans les programmes d’études en sciences de la santé par rapport aux concepts de soins de fin de vie. Méthodologie : Nous avons mené une étude qualitative exploratoire dans une province canadienne en utilisant la description interprétative, l’analyse des champs de force et le changement en trois étapes. Nous avons interrogé dix informateurs clés, représentant les programmes provinciaux de sciences de la santé en médecine, sciences infirmières, pharmacie et du travail social. Ces informateurs clés assumaient diverses fonctions, entre autres celui de coordinateur du cursus, de doyen associé et d’enseignant. Les données ont été analysées par la méthode comparative en utilisant NVivo12. Résultats : Les structures des cursus, les ressources, l’aisance et le contexte de pratique des professeurs, ainsi que l’incertitude des étudiants quant à leur champ d’exercice ont tous influé sur l’inclusion de l’AMM. Les étudiants en médecine et en pharmacie ont été systématiquement exposés à l’AMM, tandis que l’inclusion de l’AMM au programme d’études en sciences infirmières et en travail social a été déterminée par le corps enseignant en tenant compte des objectifs préexistants des cours. Les aspects théoriques et juridiques de l’AMM étaient plus systématiquement enseignés que les soins cliniques lorsque le corps professoral ne disposait pas d’un contexte de pratique. Les trajectoires de soins, les normes relatives à l’homologation, les experts de la pratique, les données probantes et les statistiques locales ont été identifiés comme ressources nécessaires pour soutenir l’apprentissage des étudiants. L’enseignement de l’AMM a été dispensé en même temps que les cours sur les soins palliatifs, l’éthique, les aspects juridiques et la réglementation professionnelle. Conclusion : L’ajout de l’AMM aux cursus en sciences de la santé est crucial pour soutenir les étudiants dans ce nouveau contexte de pratique. Il est essentiel d’identifier les moteurs et les freins qui influent sur l’inclusion de l’AMM dans les cursus en sciences de la santé pour assurer la globalité de la formation sur la fin de vie pour tous les étudiants

An evaluation of a walking and socialization program in long-term care: Impact on injurious falls

The effects of a walking program in long-term care (LTC) are affected by multiple comorbidities and the LTC milieu. We randomly assigned residents 60 years and older into three groups (walking, socializing and control). Interventions were delivered five days weekly up to 30 minutes daily. Measurements were performed at baseline, 8, 16, 24 and 32 weeks, and included falls, grip strength, Berg Balance Scale, Senior Fitness Test, and Geriatric Depression Scale Short Form. Survival analysis with 168 participants for time to first injurious fall showed a significant (p=0.001) interaction between age and sex, with fall risk increasing with age in females, but lowest in the oldest age group in males. The hazard ratio for first injurious fall was more than doubled by the use of an antidepressant (HR=2.198, p=0.005), decreased by the score on the Berg Balance high fall risk rating (HR=0.471, p=0.010), but not affected by the activity-socialization intervention. The increased hazard of injurious falls related to antidepressants, but not depressive symptoms, suggests that the high prevalence of antidepressants in LTC needs re-evaluation. Further research efforts will need to control for alternate physical activities. This work was supported by the Saskatchewan Health Research Foundation Health Research (SHRF) Team Grant. Trial registration: ClinicalTrials.gov NCT0127780

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

Risk of Depression and Suicidality among Diabetic Patients: A Systematic Review and Meta-Analysis

The purpose of this study is to conduct a systematic review and meta-analysis to evaluate the risk of depression and suicidality among diabetic patients. Methods: Medline, PubMed, EMBASE, Cochrane library, and Psych INFO were searched for studies published from 2008 onwards. Meta-analysis was conducted to estimate the pooled effect size. Sources of heterogeneity were investigated by subgroup analysis and meta-regression. Results: In total, 5750 articles were identified and of those, 17 studies on suicidality and 36 on depression were included in this study. Our analysis suggests a positive relationship between diabetes and depression (cohort studies odds ratio (OR) 1.49, 95% confidence interval (CI): 1.36⁻1.64 and cross-sectional studies OR 2.04, 95% CI, 1.73⁻2.42). Pooled OR values for suicidal ideation, attempted suicide, and completed suicide were 1.89 (95% CI: 1.36⁻2.63), 1.45 (95% CI: 1.07⁻1.96), and 1.85 (95% CI: 0.97⁻3.52), respectively. All findings were statistically significant except for completed suicide. Conclusions: The increased risk of depression and suicidality in diabetic patients highlights the importance of integrating the evaluation and treatment of depression with diabetes management in primary healthcare settings. Further research in this area is needed

Clinical Predictors of Mortality in Adults with Intellectual Disabilities with and without Down Syndrome

Background. Mood, baseline functioning, and cognitive abilities as well as psychotropic medications may contribute to mortality in adults with and without Down Syndrome (DS). Methods. Population-based (nonclinical), community-dwelling adults with intellectual disabilities (IDs) were recruited between 1995 and 2000, assessed individually for 1–4 times, and then followed by yearly phone calls. Results. 360 participants (116 with DS and 244 without DS) were followed for an average of 12.9 years (range 0–16.1 years as of July 2011). 108 people died during the course of the followup, 65 males (31.9% of all male participants) and 43 females (27.6% of all female participants). Cox proportional hazards modeling showed that baseline practical skills, seizures, anticonvulsant use, depressive symptoms, and cognitive decline over the first six years all significantly contributed to mortality, as did a diagnosis of DS, male gender, and higher age at study entry. Analysis stratified by DS showed interesting differences in mortality predictors. Conclusion. Although adults with DS have had considerable improvements in life expectancy over time, they are still disadvantaged compared to adults with ID without DS. Recognition of potentially modifiable factors such as depression may decrease this risk

Clinical Study Clinical Predictors of Mortality in Adults with Intellectual Disabilities with and without Down Syndrome

Background. Mood, baseline functioning, and cognitive abilities as well as psychotropic medications may contribute to mortality in adults with and without Down Syndrome (DS). Methods. Population-based (nonclinical), community-dwelling adults with intellectual disabilities (IDs) were recruited between 1995 and 2000, assessed individually for 1-4 times, and then followed by yearly phone calls. Results. 360 participants (116 with DS and 244 without DS) were followed for an average of 12.9 years (range 0-16.1 years as of July 2011). 108 people died during the course of the followup, 65 males (31.9% of all male participants) and 43 females (27.6% of all female participants). Cox proportional hazards modeling showed that baseline practical skills, seizures, anticonvulsant use, depressive symptoms, and cognitive decline over the first six years all significantly contributed to mortality, as did a diagnosis of DS, male gender, and higher age at study entry. Analysis stratified by DS showed interesting differences in mortality predictors. Conclusion. Although adults with DS have had considerable improvements in life expectancy over time, they are still disadvantaged compared to adults with ID without DS. Recognition of potentially modifiable factors such as depression may decrease this risk

Short- and long-term efficacy and safety of risperidone in adults with disruptive behavior disorders

Rationale Function in society can be severely affected by disruptive behaviors in adults. Objectives To examine the efficacy and safety of risperidone in the treatment of disruptive behavior disorders in intellectually disabled adults. Methods Intellectually disabled patients with disruptive behavior disorder were randomly assigned to receive risperidone (n=39) in a flexible dosage ranging from 1 to 4 mg/day (mean dosage, 1.45±0.08 mg/day) or placebo (n=38) for 4 weeks of double-blind treatment. Efficacy at endpoint was measured primarily by using the Aberrant Behavior Checklist (ABC); secondary efficacy measures included the Behavior Problems Inventory and Clinical Global Impressions scales. After this 4-week period, patients could enter open-label treatment with risperidone for 48 weeks. Results Risperidone was well tolerated, and patients treated with risperidone demonstrated significantly greater improvement at endpoint on the ABC than those who received placebo [–27.3 points (52.8% improvement) versus –14.9 points (31.3% improvement); P=0.036] and also improved on Behavior Problems Inventory and Clinical Global Impressions ratings. Over the 48-week, open-label follow-up period, there was a further decrease of 6.3 points (P0.05) on the ABC for patients who initially received risperidone and a decrease of 11.3 points (P0.05) for patients who initially received placebo and were switched to open-label risperidone. These results were achieved with a mean modal dosage of 1.8 mg/day. Conclusion Risperidone is efficacious and well tolerated in managing disruptive behavior disorders in adults with intellectual disabilit

Trajectories of Life Satisfaction and their Predictors among Korean Older Adults

Abstract Background Among older adults, life satisfaction (LS) correlates with health, mortality, and successful ageing. As various potential threats to LS tend to increase with advancing years, patterns of age-related changes in LS among older adults remain inconsistent. This study aimed to identify LS trajectories in older adults and the characteristics of individuals who experience them. Methods Large-scale, nationally representative, longitudinal data collected from 2005 to 2013 were analyzed for this study. The outcome measure was a summary of multidimensional domains influencing LS: health, finance, housing, neighbor relationships, and family relationships. Latent class growth models and logistic regression models were used to identify trajectory groups and their predictors, respectively. Results Within 3517 individuals aged 65 or older, five trajectories were identified across eight follow-up years: “low-stable” (TG1; n = 282; 8%), “middle-stable” (TG2; n = 1146; 32.6%), “improving” (TG3; n = 75; 2.1%), “upper middle-stable” (TG4; n = 1653; 47%), and “high” (TG5; n = 361; 10.3%). High trajectory individuals more frequently had higher education, financial security, good physical health, and good mental health than those in the stable, but less satisfied, groups. Similarly, compared to the largest group (upper middle-stable trajectory), individuals in the low-stable or middle-stable trajectory group not only had poorer physical and mental health but were more likely to be living alone, financially stressed, and residing in urban locations. Individuals with improving trajectory were younger and in poorer mental health at baseline compared to the upper middle-stable trajectory group. Conclusion Life satisfaction in the older follows distinct trajectories. For older adults, trajectories are stable over time and predictable, in part, from individual characteristics. Knowledge of these patterns is important for effective policy and program development

Trajectories of Life Satisfaction and their Predictors among Korean Older Adults

Abstract Background Among older adults, life satisfaction (LS) correlates with health, mortality, and successful ageing. As various potential threats to LS tend to increase with advancing years, patterns of age-related changes in LS among older adults remain inconsistent. This study aimed to identify LS trajectories in older adults and the characteristics of individuals who experience them. Methods Large-scale, nationally representative, longitudinal data collected from 2005 to 2013 were analyzed for this study. The outcome measure was a summary of multidimensional domains influencing LS: health, finance, housing, neighbor relationships, and family relationships. Latent class growth models and logistic regression models were used to identify trajectory groups and their predictors, respectively. Results Within 3517 individuals aged 65 or older, five trajectories were identified across eight follow-up years: “low-stable” (TG1; n = 282; 8%), “middle-stable” (TG2; n = 1146; 32.6%), “improving” (TG3; n = 75; 2.1%), “upper middle-stable” (TG4; n = 1653; 47%), and “high” (TG5; n = 361; 10.3%). High trajectory individuals more frequently had higher education, financial security, good physical health, and good mental health than those in the stable, but less satisfied, groups. Similarly, compared to the largest group (upper middle-stable trajectory), individuals in the low-stable or middle-stable trajectory group not only had poorer physical and mental health but were more likely to be living alone, financially stressed, and residing in urban locations. Individuals with improving trajectory were younger and in poorer mental health at baseline compared to the upper middle-stable trajectory group. Conclusion Life satisfaction in the older follows distinct trajectories. For older adults, trajectories are stable over time and predictable, in part, from individual characteristics. Knowledge of these patterns is important for effective policy and program development