The Health of People with Intellectual Disability

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Sunlight exposure and vitamin D status of older people in residential aged care

Aims: Determine the vitamin D (25OHD) response to therapeutic sun exposure in older people in residential aged care, and identify factors that determined sun exposure. Methods: In a 12 month cluster randomised controlled trial (RCT) of sunlight exposure and calcium, the main outcomes were falls’ rate and changes in 25OHD. UVR dose was estimated from ambient solar UV Index data. Multiple linear regression was used to test if UVR dose predicted vitamin D response. Adherence factors were identified through semi-structured interviews and focus groups. Outdoor spaces of residential facilities were assessed. Results: Adherence to sunlight exposure was low and there was no significant decrease in falls’ risk or increase in 25OHD except in those with higher attendance rates. The significant predictors of 25OHD at six months were UVR exposures in spring-summer and autumn-winter, and baseline vitamin D. Poor health, physical constraints and lack of autonomy were barriers to attendance. Design features of outdoor spaces hindered their use. Conclusion: Older people have the capacity to produce vitamin D from natural sunlight UVR, but vitamin D response was minimal due to poor adherence. Safe sun exposure can be encouraged in this population by addressing the barriers identified in this study

Complex support needs profile of an adult cohort with intellectual disability transitioning from state-based service provision to NDIS-funded residential support

Background: People with intellectual disability and chronic and complex support needs often require unique models of care that are intensive and expensive. How these supports can be continued within a rapidly changing policy and funding context in Australia, has not been fully determined. Method: This descriptive study utilised a retrospective electronic case-file audit design. Demographic details, chronic health conditions, medications, behaviours of concern, and overall support needs profile were mapped for 41 participants. Results: The profile is one of an ageing cohort, with high levels of chronicity and polypharmacy that requires a specialised workforce to fully meet their support needs. Conclusion: As the people with ID in this cohort age, the training needs of the current and future workforce will need to adapt as different issues become more prominent. How the national disability health and policy settings can best accommodate these support needs remains unclear

[In Press] Analysis of an Australian death database of people with intellectual disability living out of the family home : place of death and associated variables

This study reports on a five-year data set about the deaths of 599 individuals in New South Wales Australia, who at the time of their death were living in out-of-home care. Analysis aimed to: i) gain a clearer understanding of place of death for people with intellectual disability; and ii) identify and analyse associated variables to investigate how well they predict place of death for this population. Hospital admissions, polypharmacy and living situation were the strongest standalone predictors of place of death. A hospital death was more likely if the target population were subject to polypharmacy, lived in a group home, had a moderate intellectual disability or had GORD. Death, and place of death, is an issue requiring individual consideration. This study has identified some of the variables that need attention when supporting people with intellectual disability to have a good death

Analysis of the Client Death Notification (CDN) Database: Report to NSW Family & Community Services

The current Client Death Notification (CDN database offers a rich source of data analysis about the circumstances at death for 599 clients in NSW accommodation services for the five-year period 2012 to 2016. This report has detailed these circumstances. The analysis has also brought to light a number of issues. Problems with policy compliance pertaining to police notification, health policy, and palliative care plans were identified, each of which can be addressed by training and ongoing monitoring of due diligence in CDN processes. Moving forward, the development of an online data collection system would improve data fidelity. Database design to allow year-on-year comparison, as well as with like data from other data sets, would significantly improve the quality and depth of data reporting. Finally, with NSW FACS ADHC withdrawal from operational accommodation services under the NDIS, we propose that this is an opportune time to consider the development of a national reporting system. The CDN database is an important data set, offering critical information about where people with intellectual disability in accommodation services die, and the relationships between associated variables

The place of death and associated variables for clients in out-of-home care in New South Wales Australia

Introduction: In the state of New South Wales (NSW) Australia the legislation requires that deaths of people with disability living in, or temporarily absent from, a government assisted accommodation service are reportable to the Coroner. Collated data from this reporting require-ment offers information about where people with disability die, details of the death, and accommodation and health conditions at the time of death. Methods: Using a de-identified version of the collated database we analysed the reported deaths for 599 people with intellectual disability who had died during 2012 to 2016 across NSW. Results: The data set will be described in terms of key variables, including number of deaths per year, place of death, expectancy of death, and associated health risks. Significant relationships between place of death and policy compliance will also be described; for example compliance with coronial death reporting, and presence of health care plans. Implications: Recommendations about future data collection will be presented with a focus on policy compliance, data fidelity, and data collection methods. The findings will be discussed in light of Australia’s current move from a state-based to national reporting system for out-of-home deaths

Intellectual disability health content within medical curriculum: an audit of what our future doctors are taught

Background: There is a high burden of unmet health needs for people with intellectual disability. Despite experiencing significantly higher rates of morbidity and mortality compared with the general population, this group faces greater barriers to accessing healthcare. While increasing workplace capacity is one way to reduce this inequitable access, previous research indicates a scarcity of undergraduate teaching in intellectual disability. The aim of the study was to determine the extent and nature of intellectual disability content currently offered within medical degree curricula

Intellectual disability content within tertiary medical curriculum: how is it taught and by whom?

Background: Individuals with intellectual disability experience higher rates of physical and mental health conditions compared with the general population, yet have inequitable access to health care services. Improving the workplace capacity of medical professionals to meet the needs of this population is one way to reduce barriers to care and improve health outcomes. Using diverse pedagogy appropriate to learning outcomes to teach medical students about intellectual disability is a necessary step in improving future workplace capacity. However, there is a lack of research into how, and by whom, medical students are taught about intellectual disability. The aim of this study was to investigate this through an audit of Australian medical school curricula.Methods: The Deans of Australian universities that provide accredited medical degrees (n = 20) were invited by email to participate in a two-phase audit of intellectual disability content in the curricula. Phase 1 (n = 14 schools) involved the Dean's delegate completing a telephone interview or questionnaire regarding medical course structure. If intellectual disability content was identified, a unit coordinator was invited to complete a survey regarding how this content was taught and by whom (Phase 2; n = 12 schools).Results: There was considerable variability across Australian medical schools regarding methods used to teach content about intellectual disability. Didactic teaching methods were most frequently used (62% of units included some form of lecture), but workshops and tutorials were reasonably well represented (34% of units contained one or both). Thirty-six percent of units included two or more teaching methods. Almost all schools (83%) used some problem- and/or enquiry-based learning. Educator backgrounds included medicine, nursing, and allied health. A majority of schools (n = 9, 75%) involved people with intellectual disability designing and teaching content but the extent to which this occurred was inconsistent.Conclusions: Renewing curricula around intellectual disability across all medical schools by introducing varied teaching methods and the inclusion of people with intellectual disability would assist students to develop knowledge, skills, attitudes, and confidence in intellectual disability health. Such renewal offers the potential to reduce barriers to service this population regularly face, thereby improving their health outcomes

Has teaching about intellectual disability healthcare in Australian medical schools improved? A 20-year comparison of curricula audits

BACKGROUND: People with intellectual disability (ID) have multiple and complex health needs, more frequent healthcare episodes, and experience poorer health outcomes. Research conducted two decades ago showed that medical professionals were lacking in the knowledge and skills required to address the complex needs of this patient group. The aim of the current study was to determine whether Australian undergraduate medical schools that offer ID health education content had changed the amount and nature of such teaching over this period. METHODS: Identical or equivalent questionnaire items were compared across eight Australian medical schools that participated in curricula audits conducted in 1995 (referred to as T1) and 2013/14 (T2). The audits were of the nature of the ID content, methods used to teach it, and who taught it. RESULTS: There was no significant difference in the number of hours of compulsory ID content offered to medical students at T2 (total = 158.3 h; median = 2.8 h per ID unit) compared with T1 (total = 171 h; median = 2.5 h). At T2 compared with T1, units with ID content taught in the area of general practice had increased (2 units; 3.6% to 7 units; 16.3%), while decreases were seen in paediatrics (22 units; 40.0% to 10 units; 23.3%) and psychiatry (10 units; 18.2% to 4 units; 9.3%). The number of schools using problem- and/or enquiry-based learning rose to six at T2 from one at T1. Inclusive teaching practices (people with ID develop or deliver content) in compulsory/elective units had increased at T2 (10 units; 23.3%) compared with T1 (6 units; 10.9%), but direct clinical contact with people with ID had decreased (29 units; 52.7% to 11 units; 25.6%). CONCLUSIONS: Overall, little progress has been made to address the gaps in ID education for medical students identified from an audit conducted in 1995. Renewal of ID content in medical curricula is indicated as a key element in efforts to improve workforce capacity in this area and reduce barriers to care, with the aim of reversing the poor health outcomes currently seen for this group