AGING AND INTELLECTUAL DISABILITY

1. AGING AND INTELLECTUAL DISABILITY Dr Nashareen Morris 20 October 2009

2. AIMS Aimed at caregivers of PWID Primary healthcare Physical health of PWID Preventative measures

3. OVERVIEW Background – why Causes of morbidity Disease specific mortality Special health needs of PWID Literature and studies overseas Meeting health needs of PWID

4. BACKGROUND Life expectancy – Down syndrome 1983 : 25yrs 1997 : 49yrs Average LE currently approx 66yrs Less than general population Future ? Equal to non –ID population (76,9 yrs) New geriatric population

5. BACKGROUND (cont.) Barriers to adequate healthcare Communication Anxiety Do not recognise significance of symptoms Deficits in service provision (lack of resources, Lack of trained staff, continuity of care, diagnostic overshadowing) Healthcare inequality –SA vs developed countries

6. TRENDS IN HEALTHCARE FOR PWID Traditional approach : Palliative care Custodial care Concept of ‘illness’ and ID Current thinking : Preventative Participative Health defined as state of emotional, social and mental well-being and it’s reciprocal relationship with physical well-being

7. MORBIDITY Present earlier than general population Atypical presentation (challenging behaviour, loss of skills) More specific health problems More often multiple chronic physical illnesses (approx 5 medical conditions on average) Diagnosis and treatment more complicated Est 50% of health problems undiagnosed Different patterns of morbidity Longer recovery time More hospitalisations ( ?SA) Excess in mortality when compared to general population Rapid deterioration if untreated with more complications

8. EYES Down syndrome : ocular changes > 35yrs 50 – 59 yrs 33% mod to severe visual loss Cataracts, corneal abnormalities, refractive errors, nystagmus more common More severe ID – higher prevalence of visual impairment

9. EARS Non –ID population – 25% 65-74 yrs -50% > 85 yrs Down syndrome may experience hearing loss from age 50 Impacted earwax – tinnitus, may mimic dementia in person with Down syndrome

10. ORAL HEALTH Higher incidence of caries and periodontal disease Contributes to eating, speech, sleep, pain Extractions – under GA Limited access to adequate and appropriate dental care NEEDS DENTAL EXAMINATIONS THROUGHOUT LIFETIME

11. THYRIOD Very seldom routinely checked Higher prevalence esp in Down syndrome

12. Cardiovascular Added risk factors – anti-psychotics and dyslipidaemias Obesity and sedentary lifestyle Family history Metabolic syndrome Not routinely screened or followed up

13. Bone Health Osteoporosis esp problematic in severe and profound ID Average age of 1st fracture 42yrs Appendages eg fingers,toes HRT not given routinely Low levels of vit D despite Ca-supplementation Effect of AED, anti-hypertensives (Beta-blockers), injectable contraceptives Effect on quality of life after fracture

14. RESPIRATORY Risk of respiratory illness at least 3 x higher –lifetime risk Pneumonia Tuberculosis in SA context Chronic obstructive lung disease linked to smoking Respiratory illness accumalative effect with aging

15. Gastro-intestinal Peptic ulcer disease – mild/moderate ID Intestinal obstruction – severe/profound ID Constipation – link with colon cancer

16. OTHER Prostate problems – BPH, incontinence Cancer of the cervix – sexually active females, ?less than general population Dementia – Down syndrome approx 10yrs earlier, Alzheimer Menopause (DS)– earlier than general population

17. MORTALITY Excess disease specific mortality < 30 yrs Healthy survivor effect Main causes of mortality: -Vascular disease e.g. strokes, heart attacks -Respiratory illness - pneumonia -Fatal fractures -Malignancy - Dementia

18. Recommendations Vaccination – hepatitis B, Pneumovax, Influenza Health checking (structured physical exam and questionnaire at regular intervals – pref annually) Exclude physical illness when change in baseline functioning noticed