Application of Multi-Market Contact Teory to Inter-Airline Rivalry : Case of FSC vs. Lcc in the US

The minimum number of days of pedometer monitoring needed to estimate valid average weekly step counts and reactivity was investigated for older adults with intellectual disability. Participants (N 5 268) with borderline to severe intellectual disability ages 50 years and older were instructed to wear a pedometer for 14 days. The outcome measure was steps per day. Reactivity was investigated with repeated measures analysis of variance, and monitoring frame was assessed by comparing combinations of days with average weekly step counts (with intraclass correlation coefficients [ICCs] and regression analyses). No reactivity was present. Any combination of 4 days resulted in ICCs of 0.96 or higher and 90% of explained variance. The study concludes that any 4 days of wearing a pedometer is sufficient to validly measure physical activity in older adults with intellectual disability

Kwetsbaarheid bij ouderen met een verstandelijke beperking: operationalisering, risico en opsporing

Ondanks een toename in levensverwachting, is er in de oudere populatie met verstandelijke beperkingen nogal eens sprake van multipele gezondheidsproblemen en vroegtijdige functionele achteruitgang. Wij maakten gebruik van de data van de studie Gezond Ouder met een verstandelijke beperking (GOUD), om in deze populatie de kwetsbaarheid in kaart te brengen, geoperationaliseerd als een speciaal ontwikkelde kwetsbaarheidsindex van 50 items. Omdat nog niet eerder een kwetsbaarheidsindex was toegepast in een vroeg-gehandicapte populatie, moest vastgesteld worden of deze even voorspellend is voor achteruitgang van gezondheid en zelfstandigheid als in de algemene oudere populatie. In dit artikel geven wij een samenvatting van de opzet en resultaten. In een bijna-representatieve studiepopulatie van 982 50-plus cliënten van de verstandelijk gehandicaptenzorg bestudeerden wij cross-sectioneel de verdeling van kwetsbaarheid, en gedurende een follow-up van 3 jaar de predictieve validiteit. De resultaten tonen dat deze populatie gemiddeld eerder en ernstiger kwetsbaar is dan de algemene 50-plus populatie. Een hogere mate van kwetsbaarheid is voorspellend voor achteruitgang van (instrumentele) ADL en mobiliteit, toename van het medicijngebruik, hogere zorgbehoefte, en hogere sterfte, maar niet voor toename in ziekenhuisopnames. In een hypothetisch model van potentiële oorzaken van kwetsbaarheid maken wij duidelijk, waarop preventie en interventie zich moeten richten, om te komen tot meer gezonde, zelfstandige en kwalitatief bevredigende levensjaren voor deze groep

Implementation of a group-based physical activity programme for ageing adults with ID: A process evaluation

Rationale, aim and objectives This paper describes the results of the process evaluation of a physical activity programme for people with intellectual disabilities (ID), including information about the concepts 'fidelity', 'dose delivered', 'satisfaction' and 'context'. Methods Qualitative and quantitative methods among participants and programme leaders were used. Results The programme was well accepted, feasible and applicable to ageing people with ID. It was successfully implemented in terms of fidelity and dose delivered, although differences between day-activity centres were observed. Conclusions The hampering factors that are revealed in this study and the facilitating activities that were part of the implementation plan may be used by care provider services for (ageing) people with ID and other groups of people with cognitive and/or physical deficits, such as frail elderly people or people with dementia when developing and or preparing implementation of health promotion programmes

Biochemical measures and frailty in people with intellectual disabilities

Introduction: People with intellectual disabilities (ID) are earlier frail than people in the general population. Although this may be explained by lifelong unfavourable social, psychological and clinical causes, underlying physiological pathways might be considered too. Biological measures can help identify pathophysiological pathways. Therefore, we examined the association between frailty and a range of serum markers on inflammation, anaemia, the metabolic system, micronutrients and renal functioning. Methods: Participants (n = 757) with borderline to severe ID (50+) were recruited from three Dutch ID care and support services. Results: Frailty was measured with a frailty index, a measure based on the accumulation of deficits. Linear regression analyses were performed to identify associations between frailty and biochemical measures independent of age, gender, level of ID and the presence of Down syndrome. Frailty appears associated with inflammation (IL-6 and CRP), anaemia, metabolic markers (glucose, cholesterol and albumin) and renal functioning (cystatin-C and creatinine). Discussion: These results are in line with results observed in the general population. Future research needs to investigate the causal relation between biochemical measures and frailty, with a special focus on inflammation and nutrition. Furthermore, the possibility to screen for frailty using biochemical measures needs to be used

Microrint pulmonary function testing in older adults with an intellectual disability

SummaryBackgroundPulmonary function testing is not feasible in many adults with intellectual disabilities, because of difficulties with understanding and cooperation.AimsTo investigate feasibility, repeatability and reproducibility of measuring airway resistance using the interrupter technique (MicroRint) in people aged 50 years or over with a mild, moderate or severe intellectual disability.MethodSixty-seven participants were recruited through three Dutch care centres. Feasibility (percentage adequate first measurements) as well as repeatability and reproducibility were evaluated using the Intraclass Correlation Coefficient (ICC) and the within subject variation (SDw).ResultsThe group with a severe intellectual disability was too small for valid analyses and was therefore excluded. Feasibility: in 86.6% of the total study group, 88.2% of the participants with a mild and 89.7% of the people with moderate intellectual disability, the first measurement was successful. Repeatability: In the total study group, the group with a mild and the group with a moderate intellectual disability the ICC values were 0.76, 0.84 and 0.71, respectively, SDw values were 0.11kPa/l/s, 0.10kPa/l/s, 0.10kPa/l/s, respectively. Reproducibility: In the total study group, the group with a mild and the group with a moderate intellectual disability the ICC values were 0.72, 0.67 and 0.72, respectively, SDw values were 0.14kPa/l/s, 0.15kPa/l/s, 0.11kPa/l/s, respectively.ConclusionFeasibility, repeatability and reproducibility of measuring airway resistance using the MicroRint are good and acceptable in people with a mild or moderate intellectual disability aged 50 years or over

Physical activity levels of children and adolescents with moderate-to-severe intellectual disability

Background: Regular participation of children and adolescents with intellectual disabilites in physical activity is important to maintain good health and to acquire motor skills. The aim of this study was to investigate the habitual physical activity in these children. Methods: Sixty-eight children and adolescents (2–18 years) with a moderate-tosevere intellectual disability were included in the analyses. They wore an accelerometer on eight consecutive days. Data was analysed by use of descriptive statistics and multiple linear regression analyses. Results: The participants took on average 6,677 ± 2,600 steps per day, with intensity of 1,040 ± 431 counts per minute. In total, 47% of the participants were meeting physical activity recommendations. Low motor development was associated with low physical activity. Conclusions: As more than half of the participants were not meeting the recommendations, family and caregivers of these children should focus on supporting and motivating them to explore and expand their physical activities

Feasibility of bioelectrical impedance analysis in children with a severe generalized cerebral palsy

Objective: The need is strong for an accurate and easy-to-perform test to evaluate the nutritional state of children who have a severe generalized cerebral palsy, defined as a severe motor handicap and an intellectual disability. For that purpose, we determined the feasibility of bioelectrical impedance analysis (BIA) in these children and evaluated their nutritional state. Methods: BIA recordings were done in 35 children who had a severe generalized cerebral palsy using a single-frequency BIA device. In addition, arm span and body weight were determined. Components of feasibility were whether the children tolerated the recording and felt comfortable and whether the recording could be performed in a reproducible way (prescribed body position and stable resistance and reactance values). All recordings were performed at specialized children's daycare centers or schools. Results: One child (3%) did not tolerate the recording, whereas the remaining 34 children (71%) felt comfortable. Most children (74%) could be placed in the prescribed position, but stability of resistance values was low. Stability of resistance values was positively influenced by older age, a quiet location for the recording, feeling comfortable, and a small number of people in the room. For 29 children, we were able to calculate values for total body water and fat-free mass. Compared with age-matched reference values, these values were significantly decreased in all age groups. Conclusions: The present pilot study has demonstrated that BIA recording is a feasible nutritional assessment method in children who have severe generalized cerebral palsy. Because the test procedure was well tolerated by most children, its value for use in this specific population deserves further investigation

Causes of mortality in older people with intellectual disabilities

We aim to provide insight into the cause-specific mortality of older adults with intellectual disability (ID), with and without Down syndrome (DS), and compare this to the general population. Immediate and primary cause of death were collected through medical files of 1,050 older adults with ID, 5 years after the start of the Healthy Ageing and Intellectual Disabilities (HA-ID) study. During the follow-up period, 207 (19.7%) participants died, of whom 54 (26.1%) had DS. Respiratory failure was the most common immediate cause of death (43.4%), followed by dehydration/malnutrition (20.8%), and cardiovascular diseases (9.4%). In adults with DS, the most common cause was respiratory disease (73.3%), infectious and bacterial diseases (4.4%), and diseases of the digestive system (4.4%). Diseases of the respiratory system also formed the largest group of primary causes of death (32.1%; 80.4% was due to pneumonia), followed by neoplasms (17.6%), and diseases of the circulatory system (8.2%). In adults with DS, the main primary cause was also respiratory diseases (51.1%), followed by dementia (22.2%)

Comprehension of pictograms for pain quality and pain affect in adults with Down syndrome

Background Adults with Down syndrome (DS) are at risk for age-related painful physical conditions, but also for under-reporting pain. Pictograms may facilitate self-report of pain, because they seem suitable for the global visual processing in DS and for iconic representation of abstract concepts. Method Participants (N = 39, M age = 41.2) assigned pain qualities to pictograms, rated pain affect levels in facial scales (pictograms vs. drawn faces), and performed cognitive tests. Results Recognition of all intended pain qualities was above chance level. Pain affect levels of both facial scales were ordered equally well. Both facial scales were preferred equally we

Physical fitness is predictive for a decline in the ability to perform instrumental activities of daily living in older adults with intellectual disabilities

The ability to perform instrumental activities of daily living (IADL) is important for one's level of independence. A high incidence of limitations in IADL is seen in older adults with intellectual disabilities (ID), which is an important determinant for the amount of support one needs. The aim of this study was to assess the predictive value of physical fitness for the ability to perform IADL, over a 3-year follow-up period, in 601 older adults with ID. At baseline, an extensive physical fitness assessment was performed. In addition, professional caregivers completed the Lawton IADL scale, both at baseline and at follow-up. The average ability to perform IADL declined significantly over the 3-year follow-up period. A decline in the ability to perform IADL was seen in 44.3% of the participants. The percentage of participants being completely independent in IADL declined from 2.7% to 1.3%. Manual dexterity, balance, comfortable and fast gait speed, muscular endurance, and cardiorespiratory fitness were significant predictors for a decline in IADL after correcting for baseline IADL and personal characteristics (age, gender, level of ID, and Down syndrome). This can be interpreted as representing the predictive validity of the physical tests for a decline in IADL. This study shows that even though older adults with ID experience dependency on others due to cognitive limitations, physical fitness also is an important aspect for IADL, which stresses the importance of using physical fitness tests and physical fitness enhancing programs in the care for older adults with ID