Intellectual Disabilities
Intellectual disability is a common reason for disability in childhood, although less prominent in adult surveillance. People with intellectual disabilities experience age-related health impairments at a higher rate and earlier age than people without disability (172).
Depending on the etiology of their disability, they may be at much higher risk for both secondary conditions and comorbidities. These conditions can be lifethreatening or life-altering. Some may be prevented or treated if identified early. Down syndrome (DS) will be discussed as a separate entity, as more is known about aging with this condition. Strategies for minimizing functional limitations will be highlighted. Rehabilitation surveillance and treatments will be discussed (see Table 15.2).Intellectual Disability
Individuals with intellectual disability (ID) are living longer and experiencing most of the same illnesses as the general population (173). Their life expectancy remains somewhat less than the general population, but has steadily increased with the move away from institutionalized care (174). Community-based health care for people with ID is not well organized, and people with ID experience poorer health than the general population (175).
Cardiovascular
Janicki and colleagues noted that cardiovascular disease (CVD) and respiratory diseases were more common causes of death in the elderly with ID than in the general population, with cancers in a less prominent role (173). Although there have been discussions of significant rates of chronic health conditions and general poor health for adults with developmental disabilities, more recent studies of adults receiving state or national support in New York state, Taiwan, and Israel (82,83,176) note gradual increases in health conditions, but not with higher incidence than in the general population, and in some cases lower.
Obesity
In a cross-disability study of a South Carolina primary care practice that included almost 50% adults with developmental disabilities (DD), there was a lower odds ratio for coronary artery disease, cancer, and obesity for adults with DD in comparison to those without disabilities and compared to other disability groups (177). Although obesity was reported as low in the South Carolina study, other studies report obesity as being more common in adults with developmental disabilities. Obesity in people with ID is higher, compared to those age-matched without ID (35.4% vs 20.6% in one survey) (178). Other researchers have found twice as many people with ID to be obese as those without ID within the same community (179,180). Those with mild ID have more obesity than those with severe ID, and there can be a move out of the obesity state (181). The combination of increased obesity and mortality due to CVD lead to a recommendation of increased surveillance and prevention strategies for obesity-related disease.
Respiratory
Several authors describe respiratory ailments as important factors in morbidity and mortality of aging adults with ID (172,173,182). Janicki and colleagues identified pneumonia as the most prevalent cause of death due to respiratory illness and second only to CVD (173). Sleep apnea due to obesity is mentioned as a comorbidity and may require separate screening or sleep studies.
Health Maintenance
People with ID require the same screening for cancers, diabetes, hyperlipidemia, hypertension, bone density, and ophthalmologic and hearing disorders as the general population. Communication about the results of these screenings and plans for treatment of any abnormalities may need to be through a proxy. Prevention strategies for diseases related to obesity may need to start earlier than in the general population. Preexisting conditions of epilepsy and poor oral health should be monitored closely (183). GERD and Helicobacter pylori infection is increased in prevalence and undertreated in people with ID (184,185).
Symptoms of GERD should be queried in people with ID and treatment undertaken, as with the general population. Osteoporosis also is more prevalent in people with ID, with precipitating factors of small size, hypogonadism, and anticonvulsant therapy (186-188). Fractures are associated with frequency of falling. Screening for osteoporosis and falling should commence during early adulthood, with follow-up depending on the results.Mental Health
Mental health impairments are prevalent in elderly people with intellectual disability. Estimates vary from 20% to 70%, depending on which assessments were used and the exact population studied (189-192). Dementia, depression and general psychiatric symptoms are all more prevalent in the elderly population with ID. Each of these groups also had high numbers of health comorbidities, such as CVD, sensory impairment, and mobility problems. Researchers note that life events, such as relocation, were more frequent in adults with ID than in comparison groups (191). Medication review is a priority for clinicians treating people with ID. Polypharmacy is a significant problem for people who may not have adequate understanding of the need to report side effects or efficacy of medications. Medications should not be prescribed unless a system is in place to ensure compliance, safety, and monitoring of efficacy (183). Surveillance for mental health problems in aging people with ID should be a priority, along with treatment of physical comorbidities, which may contribute to or appear as mental health concerns.
Sexual Functioning
People with ID are often not afforded typical education, contraception options, or sexual health screening. They face a high risk of sexual abuse, are unaware of protection from sexually transmitted diseases, and are generally unsupported in attaining healthy sexual relationships (147,193,194). Women are often prescribed suppression therapy (194,195). Sterilization for women with ID is more common abroad, and related to severity and living arrangement (196). Women and men with ID can be provided with education and support for sexual functioning, and regular health screenings can be accomplished with modifications and support (147).