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Rinaldi R, Batselé E. "Is it my job?" An exploratory qualitative analysis of medical specialists' adaptation strategies when addressing the health needs of people with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023; 27:388-403. [PMID: 35503871 DOI: 10.1177/17446295221095706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Access to equal healthcare is a priority for people with intellectual disabilities. Most studies have focused on primary care providers; however, the administration of inclusive healthcare also relies on medical specialists, who should be considered a specific group because their practice varies significantly in this regard. Semi-directive interviews were conducted with 12 medical specialists to explore their representations regarding the care of people with intellectual disabilities. An inductive thematic analysis was applied to the data. The results highlighted a significant heterogeneity between practitioners' representations of people with intellectual disabilities in healthcare, current practices, and their perceptions and expectations in the process of ensuring quality care. This study highlights the importance of considering medical specialists' awareness raising and training to handle consultations with people with intellectual disabilities. From a broader perspective, a clear political framework to guide healthcare practices at the national level should be developed.
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Affiliation(s)
- Romina Rinaldi
- Université de Mons, Service d'Orthopédagogie Clinique, Mons, Belgium
| | - Elise Batselé
- Université de Mons, Service d'Orthopédagogie Clinique, Mons, Belgium
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Schwarze K, Mathmann P, Schäfer K, Brannath W, Höhne PH, Altin S, Prein L, Naghipour A, Zielonkowski SM, Wasmuth S, Kanaan O, Am Zehnhoff-Dinnesen A, Schwalen AS, Schotenröhr A, Scharpenberg M, Schlierenkamp S, Stuhrmann N, Lang-Roth R, Demir M, Diekmann S, Neumann A, Gietmann C, Neumann K. Effectiveness and costs of a low-threshold hearing screening programme ( HörGeist) for individuals with intellectual disabilities: protocol for a screening study. BMJ Open 2023; 13:e070259. [PMID: 37202136 DOI: 10.1136/bmjopen-2022-070259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION Individuals with intellectual disabilities (ID) often suffer from hearing loss, in most cases undiagnosed or inappropriately treated. The implementation of a programme of systematic hearing screening, diagnostics, therapy initiation or allocation and long-term monitoring within the living environments of individuals with ID (nurseries, schools, workshops, homes), therefore, seems beneficial. METHODS AND ANALYSIS The study aims to assess the effectiveness and costs of a low-threshold screening programme for individuals with ID. Within this programme 1050 individuals with ID of all ages will undergo hearing screening and an immediate reference diagnosis in their living environment (outreach cohort). The recruitment of participants in the outreach group will take place within 158 institutions, for example, schools, kindergartens and places of living or work. If an individual fails the screening assessment, subsequent full audiometric diagnostics will follow and, if hearing loss is confirmed, initiation of therapy or referral to and monitoring of such therapy. A control cohort of 141 participants will receive an invitation from their health insurance provider via their family for the same procedure but within a clinic (clinical cohort). A second screening measurement will be performed with both cohorts 1 year later and the previous therapy outcome will be checked. It is hypothesised that this programme leads to a relevant reduction in the number of untreated or inadequately treated cases of hearing loss and strengthens the communication skills of the newly or better-treated individuals. Secondary outcomes include the age-dependent prevalence of hearing loss in individuals with ID, the costs associated with this programme, cost of illness before-and-after enrolment and modelling of the programme's cost-effectiveness compared with regular care. ETHICS AND DISSEMINATION The study has been approved by the Institutional Ethics Review Board of the Medical Association of Westphalia-Lippe and the University of Münster (No. 2020-843 f-S). Participants or guardians will provide written informed consent. Findings will be disseminated through presentations, peer-reviewed journals and conferences. TRIAL REGISTRATION NUMBER DRKS00024804.
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Affiliation(s)
- Katharina Schwarze
- Institute for Health Care Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Philipp Mathmann
- Department of Phoniatrics and Paediatric Audiology, University Hospital Münster, Muenster, Germany
| | - Karolin Schäfer
- Department of Special Education and Rehabilitation, Education and Aural Rehabilitation of People who are Deaf or Hard of Hearing, University of Cologne, Cologne, Germany
| | - Werner Brannath
- Competence Center for Clinical Trials Bremen, University of Bremen, Bremen, Germany
| | | | | | - Lukas Prein
- Department of Phoniatrics and Paediatric Audiology, University Hospital Münster, Muenster, Germany
| | - Awa Naghipour
- Department of Phoniatrics and Paediatric Audiology, University Hospital Münster, Muenster, Germany
| | | | - Susanne Wasmuth
- Department of Phoniatrics and Paediatric Audiology, University Hospital Münster, Muenster, Germany
| | - Oliver Kanaan
- Department of Phoniatrics and Paediatric Audiology, University Hospital Münster, Muenster, Germany
| | | | - Anna Sophia Schwalen
- Department of Phoniatrics and Paediatric Audiology, University Hospital Münster, Muenster, Germany
| | - Anna Schotenröhr
- Department of Phoniatrics and Paediatric Audiology, University Hospital Münster, Muenster, Germany
| | - Martin Scharpenberg
- Competence Center for Clinical Trials Bremen, University of Bremen, Bremen, Germany
| | - Sarah Schlierenkamp
- Essener Forschungsinstitut für Medizinmanagement - EsFoMed GmbH, Essen, Germany
| | - Nicole Stuhrmann
- Practice for Otolaryngology, Phoniatrics & Paediatric Audiology, Duesseldorf-Meerbusch, Germany
- Phoniatrics and Paediatric Audiology, Head and Neck Surgery, Helios HSK, Wiesbaden, Germany
| | - Ruth Lang-Roth
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Muhittin Demir
- Department of Otorhinolaryngology, Division of Phoniatrics and Paediatric Audiology, University Medicine Essen, Essen, Germany
| | - Sandra Diekmann
- Essener Forschungsinstitut für Medizinmanagement - EsFoMed GmbH, Essen, Germany
| | - Anja Neumann
- Institute for Health Care Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Corinna Gietmann
- Department of Phoniatrics and Paediatric Audiology, University Hospital Münster, Muenster, Germany
| | - Katrin Neumann
- Department of Phoniatrics and Paediatric Audiology, University Hospital Münster, Muenster, Germany
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van Eeghen AM, Stemkens D, Fernández-Fructuoso JR, Maruani A, Hadzsiev K, Gaasterland CMW, Klein Haneveld MJ, Vyshka K, Hugon A, van Eeghen AM, van Balkom IDC. Consensus recommendations on organization of care for individuals with Phelan-McDermid syndrome. Eur J Med Genet 2023:104747. [PMID: 37003574 DOI: 10.1016/j.ejmg.2023.104747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/05/2023] [Accepted: 03/18/2023] [Indexed: 04/03/2023]
Abstract
The manifestations of Phelan-McDermid syndrome (PMS) are complex, warranting expert and multidisciplinary care in all life stages. In the present paper we propose consensus recommendations on the organization of care for individuals with PMS. We indicate that care should consider all life domains, which can be done within the framework of the International Classification of Functioning, Disability and Health (ICF). This framework assesses disability and functioning as the outcome of the individual's interactions with other factors. The different roles within care, such as performed by a centre of expertise, by regional health care providers and by a coordinating physician are addressed. A surveillance scheme and emergency card is provided and disciplines participating in a multidisciplinary team for PMS are described. Additionally, recommendations are provided for transition from paediatric to adult care. This care proposition may also be useful for individuals with other rare genetic neurodevelopmental disorders.
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Affiliation(s)
- A M van Eeghen
- Emma Center for Personalized Medicine, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, Netherlands; Advisium, 's Heeren Loo, Amersfoort, Netherlands.
| | - D Stemkens
- VSOP - National Patient Alliance for Rare and Genetic Diseases, Soest, the Netherlands
| | | | - A Maruani
- Excellence Center for Autism Spectrum & Neurodevelopmental Disorders, Inovand, Child and Adolescent Psychiatry Department, Hôpital Robert Debre, APHP, Paris, France; CRMR DICR, Rare Disease Center for Intellectual Disabilities, Defiscience, France
| | - K Hadzsiev
- Department of Medical Genetics, Medical School, University of Pécs, Pécs, Hungary
| | - C M W Gaasterland
- Emma Center for Personalized Medicine, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - M J Klein Haneveld
- Emma Center for Personalized Medicine, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Klea Vyshka
- University Hospital Robert Debre, Paris, France
| | - A Hugon
- University Hospital Robert Debre, Paris, France
| | - A M van Eeghen
- Emma Center for Personalized Medicine, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, Netherlands; Advisium, 's Heeren Loo, Amersfoort, Netherlands
| | - I D C van Balkom
- Jonx, Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands; Rob Giel Research Centre, Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
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Willems M, van Berlaer G, Maes L, Leyssens L, Koehler B, Marks L. Outcome of 10 years of ear and hearing screening in people with intellectual disability in Europe: A multicentre study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 35:123-133. [PMID: 34197010 DOI: 10.1111/jar.12923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/18/2021] [Accepted: 06/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Undetected ear and hearing problems negatively impact the quality of life of people with intellectual disability. METHODS This multicentre retrospective study describes the outcome of 10 years of ear and hearing screening in athletes with intellectual disability in seven European countries. The screening was conducted by a trained team using a strictly standardised protocol. RESULTS Of 15,363 screened athletes with intellectual disability, more than half (58.7%) needed referral for ear and/or hearing problems, ranging from 51.7% (<20 years old) to 81.4% (≥60 years old). The most commonly detected conditions were excessive/impacted earwax (40.3%), middle ear problems (30.1%) and hearing loss (27.0%), with significant differences between age groups and countries. DISCUSSION This study demonstrates an increased risk of ear and hearing problems in people with intellectual disability as compared to the general population. Considering the unawareness and impact of these problems, it is highly recommended to organise systematic screening. Follow-up for diagnostic elaboration, therapeutic management and long-term guidance should be provided.
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Affiliation(s)
- Melina Willems
- Audiology Department, Artevelde University of Applied Sciences, Ghent, Belgium.,Special Olympics Healthy Hearing Program, Washington, DC, USA
| | - Gerlant van Berlaer
- Department of Emergency Medicine, University Hospital Brussels, Brussels, Belgium
| | - Leen Maes
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.,Ear Nose Throat Department, Ghent University Hospital, Ghent, Belgium
| | - Laura Leyssens
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | | | - Luc Marks
- Ghent University Hospital, Oral Health in Special Needs, Ghent, Belgium
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Wood S, Standen P. Is speech and language therapy effective at improving the communication of adults with intellectual disabilities?: A systematic review. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:435-450. [PMID: 33624400 DOI: 10.1111/1460-6984.12601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 11/30/2020] [Accepted: 01/08/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND A significant proportion of adults with intellectual disabilities (ID) experience speech, language and communication difficulties which are associated with poor physical and mental health outcomes. Speech and language therapy (SLT) interventions are an important way to address these communication difficulties, yet there is limited available evidence to provide information about the effectiveness of the different approaches used for this heterogeneous group. AIMS To review the evidence available for the effectiveness of SLT interventions aimed at improving communication for adults with ID. METHODS & PROCEDURES A systematic search across relevant databases was performed. Information on methodological details of each relevant study, along with descriptions of the SLT interventions employed, were extracted and the Crowe Critical Appraisal Tool (CCAT) was used to assess quality. Findings were discussed in a narrative synthesis grouped by target communication skill. OUTCOMES & RESULTS A total of 10 relevant studies met the inclusion criteria. These were predominantly interventions aimed directly at adults with ID to improve speech, increase augmentative and alternative communication (AAC) use and develop interaction skills, with one study addressing work with carers. The included studies were all rated as low quality. There is weak preliminary evidence that SLT input can improve the communication skills of adults with ID. CONCLUSIONS & IMPLICATIONS There is insufficient evidence to draw strong conclusions about the effectiveness of SLT in this population. Further high-level evidence across speech, language and communication domains is urgently needed. What this paper adds What is already known on the subject There is limited evidence for community health interventions used with adults with ID. Previous reviews of SLT interventions found a lack of evidence base for this population. Some areas of SLT practice such as AAC have demonstrated potential benefits and other areas including speech work, social communication skills and training for communication partners have some evidence base for children with ID but there is currently insufficient evidence for adults with ID. What this paper adds to existing knowledge The study systematically reviews the current evidence base available when considering the effectiveness of SLT intervention for adults with ID. It provides weak evidence to suggest SLT intervention can improve communication in this population and highlights the need for clinically relevant, robustly designed studies to be undertaken in this field. What are the potential or actual clinical implications of this work? The lack of high-quality studies with sufficient power to draw conclusions about effectiveness means SLTs are not able to base their intervention choices on firm evidence. There is an urgent need to conduct robust research into the effectiveness of SLT interventions for adults with ID.
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Affiliation(s)
- Siȃn Wood
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Penny Standen
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
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Kinnear D, Rydzewska E, Dunn K, Hughes-McCormack L, Melville C, Henderson A, Cooper SA. The relative influence of intellectual disabilities and autism on sensory impairments and physical disability: A whole-country cohort of 5.3 million children and adults. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 33:1059-1068. [PMID: 32187783 PMCID: PMC8641374 DOI: 10.1111/jar.12728] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/29/2020] [Accepted: 03/02/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Intellectual disabilities and autism are lifelong and often co-occur. Little is known on their extent of independent association with sensory impairments and physical disability. METHODS For Scotland's population, logistic regressions investigated age-gender-adjusted odds ratios (OR) of associations, independently, of intellectual disabilities and autism with sensory impairments and physical disability. RESULTS 1,548,819 children/youth, and 3,746,584 adults. In children/youth, the effect size of intellectual disabilities and autism, respectively, was as follows: blindness (OR = 30.12; OR = 2.63), deafness (OR = 13.98; OR = 2.31), and physical disability (OR = 43.72; OR = 5.62). For adults, the effect size of intellectual disabilities and autism, respectively, was as follows: blindness (OR = 16.89; OR = 3.29), deafness (OR = 7.47; OR = 2.36), and physical disability (OR = 6.04; OR = 3.16). CONCLUSIONS Intellectual disabilities have greater association with the population burden of sensory impairments/physical disability, but autism is also associated regardless of overlap with intellectual disabilities. These may impact further on communication limitations due to autism and intellectual disabilities, increasing complexity of assessments/management of other health conditions. Clinicians need to be aware of these important issues.
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Affiliation(s)
- Deborah Kinnear
- Mental Health and Wellbeing Group, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ewelina Rydzewska
- Mental Health and Wellbeing Group, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Kirsty Dunn
- Mental Health and Wellbeing Group, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Laura Hughes-McCormack
- Mental Health and Wellbeing Group, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Craig Melville
- Mental Health and Wellbeing Group, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Angela Henderson
- Mental Health and Wellbeing Group, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sally-Ann Cooper
- Mental Health and Wellbeing Group, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Bauer A, Taggart L, Rasmussen J, Hatton C, Owen L, Knapp M. Access to health care for older people with intellectual disability: a modelling study to explore the cost-effectiveness of health checks. BMC Public Health 2019; 19:706. [PMID: 31174506 PMCID: PMC6556058 DOI: 10.1186/s12889-019-6912-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 04/29/2019] [Indexed: 01/09/2023] Open
Abstract
Background Whilst people with intellectual disability grow older, evidence has emerged internationally about the largely unmet health needs of this specific ageing population. Health checks have been implemented in some countries to address those health inequalities. Evaluations have focused on measuring process outcomes due to challenges measuring quality of life outcomes. In addition, the cost-effectiveness is currently unknown. As part of a national guideline for this population we sought to explore the likely cost-effectiveness of annual health checks in England. Methods Decision-analytical Markov modelling was used to estimate the cost-effectiveness of a strategy, in which health checks were provided for older people with intellectual disability, when compared with standard care. The approach we took was explorative. Individual models were developed for a selected range of health conditions, which had an expected high economic impact and for which sufficient evidence was available for the modelling. In each of the models, hypothetical cohorts were followed from 40 yrs. of age until death. The outcome measure was cost per quality-adjusted life-year (QALY) gained. Incremental cost-effectiveness ratios (ICER) were calculated. Costs were assessed from a health provider perspective and expressed in 2016 GBP. Costs and QALYs were discounted at 3.5%. We carried out probabilistic sensitivity analysis. Data from published studies as well as expert opinion informed parameters. Results Health checks led to a mean QALY gain of 0.074 (95% CI 0.072 to 0.119); and mean incremental costs of £4787 (CI 95% 4773 to 5017). For a threshold of £30,000 per QALY, health checks were not cost-effective (mean ICER £85,632; 95% CI 82,762 to 131,944). Costs of intervention needed to reduce from £258 to under £100 per year in order for health checks to be cost-effective. Conclusion Whilst findings need to be considered with caution as the model was exploratory in that it was based on assumptions to overcome evidence gaps, they suggest that the way health systems deliver care for vulnerable populations might need to be re-examined. The work was carried out as part of a national guideline and informed recommendations about system changes to achieve more equal health care provisions. Electronic supplementary material The online version of this article (10.1186/s12889-019-6912-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Annette Bauer
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London, England, WC2A 2AE, UK.
| | - Laurence Taggart
- Institute of Nursing & Health Research, Ulster University, N Ireland, Newtownabbey, BT37 0QB, UK
| | - Jill Rasmussen
- Royal College of General Practitioners (RCGP), 30 Euston Square, London, England, NW1 2FB, UK
| | - Chris Hatton
- Centre for Disability Research, Division of Health Research, Lancaster University, Lancaster, England, LA1 4YG, UK
| | - Lesley Owen
- National Institute for Health and Care Excellence, 10 Spring Gardens, London, England, SW1A 2BU, UK
| | - Martin Knapp
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London, England, WC2A 2AE, UK
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van Timmeren DEA, Deddens A, van Schrojenstein Lantman-de Valk HMJ, van der Schans CP, Krijnen WP, Waninge A, van der Putten AAJ. The convergent validity of a Dutch Screening tool for Dysphagia (Signaleringslijst Verslikken) for people with severe or profound intellectual and multiple disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 32:994-1001. [PMID: 30990246 DOI: 10.1111/jar.12592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 02/14/2019] [Accepted: 02/27/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Dysphagia is potentially life-threatening and highly prevalent in people with severe/profound intellectual and multiple disabilities (SPIMD). The "Signaleringslijst Verslikken" (SV) is a frequently used Dutch screening tool to detect dysphagia. The aim was to examine the convergent validity of the SV for people with SPIMD. METHOD Direct support staff completed the SV, with speech and language therapists scoring a validated tool, the Dysphagia Disorders Survey (DDS), for 41 persons with SPIMD, aged ≥50 years. The results were compared for agreement using the McNemar's Test. RESULTS The proportion of agreement was 0.59 (95% CI 0.43-0.72). The SV did not detect dysphagia in 17 participants (44%) who were assessed as having dysphagia according to the DDS. The difference in proportion of detection of dysphagia between the two methods was significant (p < 0.0001). CONCLUSIONS The results suggest that the convergent validity of the SV is insufficient: the SV is not sensitive for detecting dysphagia in people with SPIMD.
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Affiliation(s)
- Dinette E A van Timmeren
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
| | | | | | - Cees P van der Schans
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.,Department of Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Health Psychology Research, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Wim P Krijnen
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Aly Waninge
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.,Royal Dutch Visio-De Brink, Vries, The Netherlands
| | - Annette A J van der Putten
- Faculty of Behavioural and Social Sciences, Department of Special Needs Education and Youth Care, University of Groningen, Groningen, The Netherlands
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Kinnear D, Morrison J, Allan L, Henderson A, Smiley E, Cooper SA. Prevalence of physical conditions and multimorbidity in a cohort of adults with intellectual disabilities with and without Down syndrome: cross-sectional study. BMJ Open 2018; 8:e018292. [PMID: 29431619 PMCID: PMC5829598 DOI: 10.1136/bmjopen-2017-018292] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To investigate the prevalence of multimorbidity in adults with intellectual disabilities with and without Down syndrome. DESIGN Large, population-based cross-sectional study. SETTING The geographical area of one Health Board, Scotland. PARTICIPANTS All adults (aged 16+ years) known to general practitioners to have intellectual disabilities and adults receiving services provided or paid by intellectual disabilities health or social work services. 1023/1562 potential participants took part (65.5%); 562 (54.9%) men and 461 (45.1%) women, aged 43.9 years (16-83 years). 186 had Down syndrome and 837 did not. MAIN OUTCOME MEASURES The prevalence of International Statistical Classification of Diseases, 10th revision, physical health conditions and multimorbidity detected at a comprehensive health assessment. RESULTS The mean number of physical health conditions/participant was 11.04, and 98.7% had multimorbidity. The most prevalent conditions are painful and/or disabling and, in some cases, life threatening. The five most prevalent were visual impairment, obesity, epilepsy, constipation and ataxic/gait disorders. The pattern of multimorbidity differs from that seen in the general population and is spread across the entire adult life course. The extent of multimorbidity in the adults with Down syndrome was similar to that of the adults without Down syndrome, while the prevalence of individual conditions differed. CONCLUSIONS This robustly designed study with a large population found an extremely high prevalence of multimorbidity in adults with intellectual disabilities across the entire adult life course. This increases complexity of medical management that secondary healthcare services and medical education are not yet geared towards, as these tend to focus on single conditions. This is in addition to complexity due to limitations in communication and understanding. As the physical conditions within their multimorbidity also differ from that seen in the older general population, urgent attention is needed to develop the care pathways and guidelines that are required to inform and so improve their healthcare.
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Affiliation(s)
- Deborah Kinnear
- Mental Health and Wellbeing Research Group, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jill Morrison
- General Practice and Primary Care Research Group, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Linda Allan
- Mental Health and Wellbeing Research Group, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Angela Henderson
- Mental Health and Wellbeing Research Group, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Elita Smiley
- East Renfrewshire Integrated Learning Disability Team, Barrhead Health & Care Centre, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Sally-Ann Cooper
- Mental Health and Wellbeing Research Group, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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10
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van Timmeren EA, van der Schans CP, van der Putten AAJ, Krijnen WP, Steenbergen HA, van Schrojenstein Lantman-de Valk HMJ, Waninge A. Physical health issues in adults with severe or profound intellectual and motor disabilities: a systematic review of cross-sectional studies. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2017; 61:30-49. [PMID: 27228900 DOI: 10.1111/jir.12296] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 04/07/2016] [Accepted: 04/08/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND People with severe or profound intellectual and motor disabilities (SPIMD) encounter several risk factors associated with higher mortality rates. They are also likely to experience a cluster of health problems related to the severe brain damage/dysfunction. In order to earlier detect physical health problems in people with SPIMD, first of all, knowledge regarding the prevalence of physical health problems is necessary. The aim of this systematic review was to methodically review cross-sectional studies on the prevalence of various types of physical health problems in adults with SPIMD. METHOD MedLine/PubMed, CINAHL, Embase, PsycINFO and Web of Science were searched for studies published between 2004 and 2015. The quality of the incorporated studies was assessed utilising an adjusted 'risk of bias tool' for cross-sectional studies. To estimate the prevalence of the health problems, the proportion and corresponding confidence interval were calculated. A random effect meta-analysis was performed when at least three studies on a specific health problem were available. RESULTS In total, 20 studies were included and analysed. In the meta-analysis, a homogeneous prevalence rate of 70% (CI 65-75%) was determined for epilepsy. Heterogeneous results were ascertained in the meta-analysis for pulmonary/respiratory problems, hearing problems, dysphagia, reflux disease and visual problems. For the health problems identified in two studies or in a single study, the degree of evidence was low. As expected, higher prevalence rates were found in the current review compared with people with ID for visual problems, epilepsy and spasticity. CONCLUSION This review provides an overview of the current state of the art research on the prevalence of health problems in adults with SPIMD. There is a substantial need for comprehensive epidemiological data in order to find clusters of health problems specific for people with SPIMD. This would provide insight into the excess morbidity associated with SPIMD.
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Affiliation(s)
- E A van Timmeren
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - C P van der Schans
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
- Department of Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A A J van der Putten
- Department of Special Needs Education and Youth Care, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - W P Krijnen
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - H A Steenbergen
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
| | | | - A Waninge
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
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11
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van Timmeren EA, van der Putten AAJ, van Schrojenstein Lantman-de Valk HMJ, van der Schans CP, Waninge A. Prevalence of reported physical health problems in people with severe or profound intellectual and motor disabilities: a cross-sectional study of medical records and care plans. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2016; 60:1109-1118. [PMID: 27197564 DOI: 10.1111/jir.12298] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 03/16/2016] [Accepted: 04/13/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND People with severe or profound intellectual and motor disabilities (SPIMD) experience numerous serious physical health problems and comorbidities. Knowledge regarding the prevalence of these problems is needed in order to detect and treat them at an early stage. Data concerning these problems in individuals with SPIMD are limited. Therefore, the aim of this study was to determine the prevalence of reported physical health problems in adults with SPIMD through a review of medical records and care plans. METHOD We conducted a cross-sectional study employing data obtained from medical and support records. A sample of adults with SPIMD was recruited in eight residential care settings. Physical health problems that had occurred during the previous 12 months or were chronic were recorded. RESULTS The records of 99 participants were included. A wide range of physical health problems were found with a mean of 12 problems per person. Very high prevalence rates (>50%) were found for constipation, visual impairment, epilepsy, spasticity, deformations, incontinence and reflux. CONCLUSIONS The results suggest that people with SPIMD simultaneously experience numerous, serious physical health problems. The reliance on reported problems may cause an underestimation of the prevalence of health problems with less visible signs and symptoms such as osteoporosis and thyroid dysfunction.
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Affiliation(s)
- E A van Timmeren
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.
| | - A A J van der Putten
- Faculty of Behavioural and Social Sciences, Department of Special Needs Education and Youth Care, University of Groningen, Groningen, The Netherlands
| | | | - C P van der Schans
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
- Department of Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A Waninge
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
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12
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Silibello G, Vizziello P, Gallucci M, Selicorni A, Milani D, Ajmone PF, Rigamonti C, De Stefano S, Bedeschi MF, Lalatta F. Daily life changes and adaptations investigated in 154 families with a child suffering from a rare disability at a public centre for rare diseases in Northern Italy. Ital J Pediatr 2016; 42:76. [PMID: 27576488 PMCID: PMC5006542 DOI: 10.1186/s13052-016-0285-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 08/03/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Living with a disabled child has profound effects on the entire family. With a prevalence of developmental disabilities around 2,5 %, there is a considerable need to promote improvements in the health care system. Little is known about changes and adaptations in the lives of affected families and this paucity of information hinders the improvement of services. This study sought to explore the needs and changes in the everyday life of families with children suffering from rare diseases of varying severity, with and without mental disability. The aim was to measure the socio-demographic characteristics, health care problems and living conditions of a large cohort of families with an affected member. METHODS A sample of 154 families was recruited between September 2011 and April 2013 to respond to a 136 item questionnaire that explored different areas of concern (diagnosis and follow-up of clinical specialists, relationship with pediatrician, rehabilitation, school, work, institutional and/or private support, child care needs and family relationships). RESULTS All parents answered the questionnaire. They were satisfied with the services provided in particular for diagnosis and follow-up, relationships with the family pediatrician, rehabilitation services and school, regardless of the severity of condition, presence of intellectual disability (ID) or absence of diagnosis. Negative scores were reported for institutional and/or private support and family relationships in severe conditions. CONCLUSIONS The Health Care System should maintain a family-centered care and a multi-agency working, improving quality of life of families with disabled child to allow adaptation. At present these services are uncoordinated and financial support is poor, resulting in a heavy burden for these families.
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Affiliation(s)
- G. Silibello
- Child and Adolescent Neuropsychiatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - P. Vizziello
- Child and Adolescent Neuropsychiatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M. Gallucci
- Department of Psychology, University of Milano, Bicocca, Italy
| | - A. Selicorni
- Pediatric Genetic Unit, Department of Pediatrics, MBBM Foundation, A.O S Gerardo, Monza, Italy
| | - D. Milani
- Pediatric Highly Intensive Care Unit Department of Pathophysiology and Transplantation Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - P. F. Ajmone
- Child and Adolescent Neuropsychiatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - C. Rigamonti
- Child and Adolescent Neuropsychiatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - S. De Stefano
- Clinical Genetics Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122 Milan, Italy
| | - M. F. Bedeschi
- Clinical Genetics Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122 Milan, Italy
| | - Faustina Lalatta
- Clinical Genetics Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122 Milan, Italy
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Pariseau-Legault P, Holmes D. Intellectual Disability: A Critical Concept Analysis. Res Theory Nurs Pract 2015; 29:249-65. [PMID: 26714353 DOI: 10.1891/1541-6577.29.4.249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Over the last number of years, the emergence of new scientific and social constructions of intellectual disability has contributed to many terminological, conceptual, and structural changes. As a result, the expression "mental retardation" has gradually been abandoned in favor of "intellectual disability" for classification and diagnosis. In addition to helping redefine intellectual disability, the implementation of new deinstitutionalized mechanisms of governmentality required the adoption of different clinical models. Concrete applications of those models have yet to be studied in nursing practice. The main objective of this article is to analyze the concept of intellectual disability in light of recent developments to clarify its philosophical bases, influence, and relevance for clinical practice. This concept analysis was realized following a literature review of scientific articles and monographs addressing topics related to intellectual disability. Inspired by a poststructuralist approach, we will discuss about the ambiguity of nurses' role regarding people labeled as having an intellectual disability. Lastly, we will address the clinical implications of our analysis and we will propose an actualized understanding of the nursing practice in such context.
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Oron Y, Shushan S, Ben-David N, Flaksman H, Korenbrot F, Merrick J, Roth Y. Guidelines for Ear, Nose, and Throat Examination of Adults With Intellectual Disabilities: Report of a Clinical Practice Application. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2015. [DOI: 10.1111/jppi.12137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Yahav Oron
- The E.Wolfson Medical Center, Holon, Israel, and Tel Aviv University Sackler School of Medicine, Israel, Tel-Aviv University Sackler School of Medicine; Holon Israel
| | - Sagit Shushan
- The E.Wolfson Medical Center, Holon, Israel, and Tel Aviv University Sackler School of Medicine, Israel, Tel-Aviv University Sackler School of Medicine; Holon Israel
| | - Nophar Ben-David
- The E.Wolfson Medical Center, Holon, Israel, and Tel Aviv University Sackler School of Medicine, Israel, Tel-Aviv University Sackler School of Medicine; Holon Israel
- National Institute of Child Health and Human Development; Jerusalem Israel
- Ministry of Social Affairs and Social Services; Jerusalem Israel
| | - Haim Flaksman
- The E.Wolfson Medical Center, Holon, Israel, and Tel Aviv University Sackler School of Medicine, Israel, Tel-Aviv University Sackler School of Medicine; Holon Israel
| | - Frida Korenbrot
- National Institute of Child Health and Human Development; Jerusalem Israel
- Ministry of Social Affairs and Social Services; Jerusalem Israel
| | - Joav Merrick
- National Institute of Child Health and Human Development; Jerusalem Israel
- Ministry of Social Affairs and Social Services; Jerusalem Israel
- Hadassah Hebrew University Medical Center; Jerusalem Israel
- University of Kentucky College of Medicine; Lexington KY USA
- Georgia State University; Atlanta GA USA
| | - Yehudah Roth
- The E.Wolfson Medical Center, Holon, Israel, and Tel Aviv University Sackler School of Medicine, Israel, Tel-Aviv University Sackler School of Medicine; Holon Israel
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MacRae S, Brown M, Karatzias T, Taggart L, Truesdale-Kennedy M, Walley R, Sierka A, Northway R, Carey M, Davies M. Diabetes in people with intellectual disabilities: A systematic review of the literature. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 47:352-374. [PMID: 26496008 DOI: 10.1016/j.ridd.2015.10.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 08/21/2015] [Accepted: 10/07/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To present an analysis of the evidence related to the prevalence of diabetes in people with intellectual disabilities (ID), their experiences of their condition and treatment and those of their carers. MATERIALS AND METHODS A systematic literature review was conducted. A total of 22 studies exploring diabetes prevalence and 5 exploring views and experiences of diabetes in people with ID were identified and included. A narrative synthesis approach was utilised to amalgamate data extracted from the included studies regarding some 49,046 participants with ID and diabetes and 31 care professionals and family members across Europe, North America, New Zealand, Australia, China and Hong Kong. RESULTS Prevalence rates of diabetes in people with ID were highly varied, ranging from 0.4% to 25%. 7 studies reported significantly higher rates of diabetes in people with ID than the general population. People with ID reported a basic understanding of diabetes and wanted to know more. Carers reported that they lack diabetes knowledge and do not routinely encourage diabetes self-management skills. Several studies neglected to report vital demographic information such as participants' level of ID (13 studies) and diabetes type (16 studies) and the quality of included prevalence studies was variable. CONCLUSIONS Further research in this field is required, notably prevalence studies which control for participant demographics and personal situations to obtain more accurate diabetes prevalence rates in this population group. People with ID and diabetes should be encouraged to participate in future research and we recommend exploring the feasibility of adapting current mainstream diabetes management programmes for these individuals.
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Affiliation(s)
- Siobhan MacRae
- Edinburgh Napier University, Faculty of Health, Life and Social Sciences, UK
| | - Michael Brown
- Edinburgh Napier University, Faculty of Health, Life and Social Sciences, UK; NHS Lothian Specialist Learning Disability Services, UK.
| | - Thanos Karatzias
- Edinburgh Napier University, Faculty of Health, Life and Social Sciences, UK; NHS Lothian, Rivers Centre for Traumatic Stress, UK
| | - Laurence Taggart
- University of Ulster, Institute of Nursing and Health Research, UK
| | | | - Robert Walley
- Edinburgh Napier University, Faculty of Health, Life and Social Sciences, UK; NHS Lothian East and Midlothian Community Learning Disability Teams, UK
| | - Anna Sierka
- Edinburgh Napier University, Faculty of Health, Life and Social Sciences, UK
| | - Ruth Northway
- University of South Wales, Faculty of Life Sciences and Education, UK
| | - Marian Carey
- Leicester Diabetes Centre, University Hospitals of Leicester, UK
| | - Melanie Davies
- Leicester Diabetes Centre, University Hospitals of Leicester, UK; University of Leicester, Diabetes Research Centre, UK
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Lennox N, Van Driel ML, van Dooren K. Supporting primary healthcare professionals to care for people with intellectual disability: a research agenda. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2015; 28:33-42. [PMID: 25530572 DOI: 10.1111/jar.12132] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND The vast health inequities experienced by people with intellectual disability remain indisputable. Persistent and contemporary challenges exist for primary healthcare providers and researchers working to contribute to improvements to the health and well-being of people with intellectual disability. Over two decades after the only review of supports for primary healthcare providers was published, this paper contributes to an evolving research agenda that aims to make meaningful gains in health-related outcomes for this group. METHODS The present authors updated the existing review by searching the international literature for developments and evaluations of multinational models of care. RESULTS Based on our review, we present three strategies to support primary healthcare providers: (i) effectively using what we know, (ii) considering other strategies that offer support to primary healthcare professionals and (iii) researching primary health care at the system level. CONCLUSIONS Strengthening primary care by supporting equitable provision of health-related care for people with intellectual disability is a much needed step towards improving health outcomes among people with intellectual disability. More descriptive quantitative and qualitative research, as well as intervention-based research underpinned by rigorous mixed-methods evaluating these strategies at the primary care level, which is sensitive to the needs of people with intellectual disability will assist primary care providers to provide better care and achieve better health outcomes. ACCESSIBLE ABSTRACT Many people with intellectual disability have poor health. The authors reviewed what has been written by other researchers about how to improve the health of people with intellectual disability. In the future, people who support adults with intellectual disability should continue doing what they do well, think of other ways to improve health, and do more research about health. At all times, the needs of people with intellectual disability should be the greatest concern for those trying to support them.
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Affiliation(s)
- Nicholas Lennox
- Queensland Centre for Intellectual and Developmental Disability, School of Medicine, The University of Queensland, Brisbane, Qld, Australia
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17
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McShea L, Fulton J, Hayes C. Paid Support Workers for Adults with Intellectual Disabilities; Their Current Knowledge of Hearing Loss and Future Training Needs. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2015; 29:422-32. [PMID: 26119454 DOI: 10.1111/jar.12201] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND People with intellectual disabilities are more likely to have hearing loss than the general population. For those unable to self-advocate, the responsibility of detection and management falls to their caregivers. METHODS This is the first cycle of a project using action research methodology to improve services. Twenty care workers were interviewed to understand their knowledge of hearing loss and hearing aids. Themes were generated using thematic analysis. FINDINGS This group was better qualified than their peers but received minimal training in hearing loss. They were unable to accurately estimate expected prevalence and had a negative perception of hearing aids. Only 7% of service users were known to have hearing loss. CONCLUSIONS Current training is not sufficient to provide the skills for detection and management of hearing problems. This group had clear ideas on methods of learning. Working in collaboration is necessary to achieve long-term change to practice.
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Affiliation(s)
- Lynzee McShea
- Audiology Department, Sunderland Royal Hospital, Sunderland, Tyne and Wear, UK
| | - John Fulton
- Faculty of Applied Sciences, University of Sunderland, Sunderland, UK
| | - Catherine Hayes
- Faculty of Applied Sciences, University of Sunderland, Sunderland, UK
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18
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Robertson J, Hatton C, Emerson E, Baines S. The impact of health checks for people with intellectual disabilities: an updated systematic review of evidence. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:2450-2462. [PMID: 24984052 DOI: 10.1016/j.ridd.2014.06.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 06/04/2014] [Accepted: 06/06/2014] [Indexed: 06/03/2023]
Abstract
Health checks for people with intellectual disabilities have been recommended as one component of international health policy responses to the poorer health of people with intellectual disabilities. This review updates a previously published review summarising evidence on the impact of health checks on the health and well-being of people with intellectual disabilities. Electronic literature searches and email contacts were used to identify literature relevant to the impact of health checks for people with intellectual disabilities published from 1989 to 2013. Forty-eight publications were identified, of which eight articles and two reports were newly identified and not included in the previous review. These involved checking the health of people with intellectual disabilities from a range of countries including a full range of people with intellectual disabilities. Health checks consistently led to detection of unmet health needs and targeted actions to address health needs. Health checks also had the potential to increase knowledge of the health needs of people with intellectual disabilities amongst health professionals and support staff, and to identify gaps in health services. Health checks are effective in identifying previously unrecognised health needs, including life threatening conditions. Future research should consider strategies for optimising the cost effectiveness or efficiency of health checks.
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Affiliation(s)
- Janet Robertson
- Centre for Disability Research, Division of Health Research, School of Health and Medicine, Lancaster University, Lancaster LA1 4YT, United Kingdom.
| | - Chris Hatton
- Centre for Disability Research, Division of Health Research, School of Health and Medicine, Lancaster University, Lancaster LA1 4YT, United Kingdom
| | - Eric Emerson
- Centre for Disability Research, Division of Health Research, School of Health and Medicine, Lancaster University, Lancaster LA1 4YT, United Kingdom; Centre for Disability Research and Policy, University of Sydney, Australia
| | - Susannah Baines
- Centre for Disability Research, Division of Health Research, School of Health and Medicine, Lancaster University, Lancaster LA1 4YT, United Kingdom
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19
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Krahn GL, Fox MH. Health disparities of adults with intellectual disabilities: what do we know? What do we do? JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2014; 27:431-46. [PMID: 23913632 PMCID: PMC4475843 DOI: 10.1111/jar.12067] [Citation(s) in RCA: 174] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Recent attention to health of people with intellectual disabilities has used a health disparities framework. Building on historical context, the paper summarizes what is known about health disparities from reports and research and provide direction on what to do to reduce these disparities among adults with intellectual disabilities. METHODS The present authors examined literature from 2002 to 2011 on health disparities and people with disabilities looking for broad themes on documenting disparities and on research approaches and methods. RESULTS Multiple countries published reports on health of people with intellectual disabilities. Researchers summarized existing research within a health disparities framework. A number of promising methodologies are identified such as health services research, health indicators, enhanced surveillance and mixed-methods. CONCLUSIONS Strategies to reduce health disparities include use of data to educate decision makers, attention to social determinants and a life-course model and emphasis on leveraging inclusion in mainstream services where possible.
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Affiliation(s)
- Gloria L Krahn
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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20
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Hahn JE. Using Nursing Intervention Classification in an Advance Practice Registered Nurse-Led Preventive Model for Adults Aging With Developmental Disabilities. J Nurs Scholarsh 2014; 46:304-13. [DOI: 10.1111/jnu.12085] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Joan Earle Hahn
- Eta Iota; Associate Professor; Department of Nursing; College of Health and Human Services; University of New Hampshire; Durham NH USA
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21
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Hithersay R, Strydom A, Moulster G, Buszewicz M. Carer-led health interventions to monitor, promote and improve the health of adults with intellectual disabilities in the community: a systematic review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:887-907. [PMID: 24495402 DOI: 10.1016/j.ridd.2014.01.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 01/06/2014] [Accepted: 01/06/2014] [Indexed: 06/03/2023]
Abstract
Using carers to help assess, monitor, or promote health in people with intellectual disabilities (ID) may be one way of improving health outcomes in a population that experiences significant health inequalities. This paper provides a review of carer-led health interventions in various populations and healthcare settings, in order to investigate potential roles for carers in ID health care. We used rapid review methodology, using the Scopus database, citation tracking and input from ID healthcare professionals to identify relevant research. 24 studies were included in the final review. For people with ID, the only existing interventions found were carer-completed health diaries which, while being well received, failed to improve health outcomes. Studies in non-ID populations show that carers can successfully deliver screening procedures, health promotion interventions and interventions to improve coping skills, pain management and cognitive functioning. While such examples provide a useful starting point for the development of future carer-led health interventions for people with ID, the paucity of research in this area means that the most appropriate means of engaging carers in a way that will reliably impact on health outcomes in this population remains, as yet, unknown.
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Affiliation(s)
- Rosalyn Hithersay
- Research Department of Mental Health Sciences, Charles Bell House, 2nd Floor, 67-73 Riding House Street, London W1W 7EJ, United Kingdom.
| | - André Strydom
- Research Department of Mental Health Sciences, Charles Bell House, 2nd Floor, 67-73 Riding House Street, London W1W 7EJ, United Kingdom
| | - Gwen Moulster
- Haringey Learning Disabilities Partnership, Cumberland House, Cumberland Road, Wood Green N22 7SJ, United Kingdom
| | - Marta Buszewicz
- Research Department of Primary Care and Population Health, Upper Third Floor, UCL Medical School (Royal Free Campus), Rowland Hill Street, London NW3 2PF, United Kingdom
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Cahill S, Stancliffe RJ, Clemson L, Durvasula S. Reconstructing the fall: individual, behavioural and contextual factors associated with falls in individuals with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2014; 58:321-332. [PMID: 23373456 DOI: 10.1111/jir.12015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/18/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Falls are a significant and recurrent problem for individuals with intellectual disability (ID). There has been little exploration of the fall event from the perspective of the individual who falls or their carers. Research has focused predominantly on personal risk factors, leaving the behavioural and contextual analysis of falls much less understood. This study aimed to identify these additional factors as well as briefly explore the fall experience for individuals and their carers. METHOD A qualitative design was used incorporating fall reconstructions and ethnographic-style interviews conducted in the home setting. Nine people with ID and their carers/family member participated: five pairs were living at home and four were in out-of-family-home settings. Interviews were recorded, transcribed verbatim and major themes identified via thematic analysis. RESULTS We identified 17 themes that contributed to falls and fell under the three headings of individual, behavioural or contextual factors. Themes include decreased physical capacity, unsafe behaviours, limited hazard awareness and the impact of others in the home on an individual's fall behaviours. Additionally, families and individuals identified a number of consequences and adaptations which they implemented to alleviate possible fall impact. CONCLUSIONS Qualitative interviews, observational methods and carer assistance are valuable in offering insight into understanding the individual, behavioural and contextual factors associated with falls in people with ID. The fall reconstruction technique may be a useful supplement when evaluating intrinsic risk in programmes designed to reduce falls.
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Affiliation(s)
- S Cahill
- Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
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23
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Hey C, Fessler S, Hafner N, Lange BP, Euler HA, Neumann K. High Prevalence of Hearing Loss at the Special Olympics: Is This Representative of People with Intellectual Disability? JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2013; 27:125-33. [DOI: 10.1111/jar.12057] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2013] [Indexed: 11/28/2022]
Affiliation(s)
- C. Hey
- Department for Phoniatrics and Pediatric Audiology; University of Frankfurt/Main; Frankfurt/Main Germany
| | - S. Fessler
- Department for Phoniatrics and Pediatric Audiology; University of Frankfurt/Main; Frankfurt/Main Germany
| | - N. Hafner
- Department for Phoniatrics and Pediatric Audiology; University of Frankfurt/Main; Frankfurt/Main Germany
| | - B. P. Lange
- Department of Medical Psychology and Medical Sociology; Center of Psychosocial Medicine; Faculty of Medicine; University of Göttingen; Göttingen Germany
| | - H. A. Euler
- Dept. of Phoniatrics and Pediatric Audiology; Clinic for ENT; Head- and Neck Surgery; St. Elisabeth Hospital; Ruhr-University Bochum; Bochum Germany
| | - K. Neumann
- Department for Phoniatrics and Pediatric Audiology; University of Frankfurt/Main; Frankfurt/Main Germany
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Doody C, Markey K, Doody O. Health of ageing people with intellectual disability and the role of the nurse in Ireland. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2012; 16:275-286. [PMID: 23027837 DOI: 10.1177/1744629512462181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The number of people with intellectual disability living into old age continues to increase. As one ages, generally, functional ability decreases and health issues increase, with recognising and responding to the health needs of the person with intellectual disability of great importance and the responsibility of the intellectual disability nurse. The nurse must review and adjust the way they deliver care to ageing people with intellectual disability, not only in terms of responding to their health needs but also through collaborative working within teams and other services. As Ireland has specifically trained nurses in intellectual disability, it has a prime opportunity to address the health needs and concerns of people with intdisability and actively advocate for how services develop and responds to the changing health needs of ageing people with intellectual disability.
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Jenkins R. The role of nurses in meeting the health care needs of older people with intellectual disabilities: a review of the published literature. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2012; 16:85-95. [PMID: 22433477 DOI: 10.1177/1744629512442032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
People with intellectual disabilities are now living longer and as a consequence are likely to have greater physical and mental health needs compared to the general population. Nurses may have a crucial role to play in meeting such needs, although it is unclear whether nurses are prepared for this role. This review of the available literature found little evidence of nurses undertaking effective interventions in meeting the health needs of older people with intellectual disabilities in the UK and Ireland. Nurses have been alerted to the increase in numbers of older people with intellectual disabilities and offered some direction on their future role in this area. Most of the available literature is based mainly on informed opinion rather than research findings.
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Robertson J, Roberts H, Emerson E, Turner S, Greig R. The impact of health checks for people with intellectual disabilities: a systematic review of evidence. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2011; 55:1009-1019. [PMID: 21726316 DOI: 10.1111/j.1365-2788.2011.01436.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Health checks for people with intellectual disabilities (ID) have been recommended as one component of health policy responses to the poorer health of people with ID. This review summarises evidence on the impact of health checks on the health and well-being of people with ID. METHODS Electronic literature searches and email contacts were used to identify literature relevant to the impact of health checks for people with ID. RESULTS A total of 38 publications were identified. These involved checking the health of over 5000 people with ID from a range of countries including a full range of people with ID. Health checks consistently led to detection of unmet health needs and targeted actions to address health needs. CONCLUSIONS Health checks are effective in identifying previously unrecognised health needs, including life-threatening conditions. Future research should consider strategies for optimising the cost-effectiveness or efficiency of health checks.
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Affiliation(s)
- J Robertson
- Centre for Disability Research, School of Health and Medicine, Lancaster University, Lancaster, UK.
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Iacono T, Lewis B, Tracy J, Hicks S, Morgan P, Récoché K, McDonald R. DVD-based stories of people with developmental disabilities as resources for inter-professional education. Disabil Rehabil 2011; 33:1010-21. [DOI: 10.3109/09638288.2010.520802] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Haveman M, Perry J, Salvador-Carulla L, Walsh PN, Kerr M, Van Schrojenstein Lantman-de Valk H, Van Hove G, Berger DM, Azema B, Buono S, Cara AC, Germanavicius A, Linehan C, Määttä T, Tossebro J, Weber G. Ageing and health status in adults with intellectual disabilities: results of the European POMONA II study. JOURNAL OF INTELLECTUAL & DEVELOPMENTAL DISABILITY 2011; 36:49-60. [PMID: 21314593 DOI: 10.3109/13668250.2010.549464] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND POMONA II was a European Commission public health-funded project. The research questions in this article focus on age-specific differences relating to environmental and lifestyle factors, and the 17 medical conditions measured by the POMONA Checklist of Health Indicators (P15). METHOD The P15 was completed in a cross-sectional design for a stratified sample of 1,253 adults with ID across 14 European member states. RESULTS Older people (55+) were more likely to live in larger residential homes. Rates of smoking and use of alcohol were lower than in the general population but were higher with older age. More than 60% of older adults had a sedentary lifestyle. Cataract, hearing disorder, diabetes, hypertension, osteoarthritis/arthrosis, and osteoporosis were positively associated with advancing age; allergies and epilepsy, negatively associated. CONCLUSIONS Some evidence of health disparities was found for older people with ID, particularly in terms of underdiagnosed or inadequately managed preventable health conditions.
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Affiliation(s)
- Meindert Haveman
- Faculty of Rehabilitation Sciences, University of Dortmund, Germany.
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While AE, Clark LL. Overcoming ignorance and stigma relating to intellectual disability in healthcare: a potential solution. J Nurs Manag 2011; 18:166-72. [PMID: 20465744 DOI: 10.1111/j.1365-2834.2009.01039.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM To propose a strategy for overcoming stigma and discrimination against people with intellectual disabilities within healthcare. BACKGROUND Evidence of poor healthcare for those with intellectual disabilities resulted in an independent inquiry. The subsequent report has charged healthcare organizations to address current organizational failings. EVALUATION The origins of discriminatory practices in health services and the evidence of persisting poor care and stigmatization of this patient group despite UK Government policy are set out. KEY ISSUE The stigmatization and resulting discrimination of people with intellectual disabilities persists. CONCLUSION In addition to investment in core training, organizational change is needed to bring about change and a reduction in health inequality. IMPLICATIONS FOR NURSING MANAGEMENT The development of a new framework for nursing is recommended with leadership at all levels of healthcare so that people with intellectual disabilities and their families can expect to receive high quality care in all healthcare settings.
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Affiliation(s)
- Alison E While
- Florence Nightingale School of Nursing & Midwifery, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA.
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McCracken W, Lumm J, Laoide-Kemp S. Hearing in Athletes with Intellectual Disabilities: The Need for Improved Ear Care. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2010. [DOI: 10.1111/j.1468-3148.2010.00564.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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31
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Gibson J, O'Connor R. Access to health care for disabled people: a systematic review. ACTA ACUST UNITED AC 2010. [DOI: 10.5042/scn.2010.0599] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Tyler C, Schramm S, Karafa M, Tang AS, Jain A. Electronic Health Record Analysis of the Primary Care of Adults with Intellectual and Other Developmental Disabilities. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2010; 7:204-210. [PMID: 26113866 DOI: 10.1111/j.1741-1130.2010.00266.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Adults with intellectual and other developmental disabilities (IDD) are at risk for sub-optimal primary health care. Electronic Health Record (EHR) analyses are an under-utilized resource for studying the health and primary care of this population. METHODS This was a case-control EHR analysis of adults with IDD provided primary care through the Cleveland Clinic between 2005 and 2008. The IDD cohort was identified by relevant ICD-9 codes in problem list and encounter diagnoses. A comparison cohort matched by age, sex, race, and insurance was also specified. Demographic, health and health service characteristics of the two cohorts were compared. FINDINGS The IDD cohort consisted of 1267 individuals, mean age 39 years, 54% male, 78% Caucasian. Age, sex, racial, and health insurance characteristics were similar in the 2534 individuals in the comparison cohort. Individuals with IDD were significantly more likely to carry diagnoses of epilepsy, constipation, osteoporosis, obesity, and hyperlipidemia; but were significantly less likely to bear diagnoses of hypertension, diabetes, osteoarthritis, heart failure, coronary heart disease, and COPD. Despite a lower mean BMI, individuals with IDD were more likely to be labeled obese. Only genetic consultation rates were higher in the IDD cohort. DISCUSSION Health services research related to persons with IDD is becoming more feasible as large health systems adopt EHRs. Further analyses from this dataset will investigate whether variations in disease rates in adults with IDD represent true differences in disease prevalence versus disparities in health care.
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Affiliation(s)
- Carl Tyler
- Cleveland Clinic Medicine Institute, Cleveland, OH ; Case Western Reserve University Department of Family Medicine, Cleveland, OH
| | | | - Matthew Karafa
- Cleveland Clinic Quantitative Health Sciences, Cleveland, OH
| | - Anne S Tang
- Cleveland Clinic Quantitative Health Sciences, Cleveland, OH
| | - Anil Jain
- Cleveland Clinic eResearch, Cleveland, OH
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Newsam H, Walley RM, McKie K. Sensory Impairment in Adults With Intellectual Disabilities-An Exploration of the Awareness and Practices of Social Care Providers. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2010. [DOI: 10.1111/j.1741-1130.2010.00267.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Manthorpe J, Martineau S. Followers or leaders? What is the role for social care practitioners in annual health checks for adults with learning disabilities? JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2010; 14:53-66. [PMID: 20630927 DOI: 10.1177/1744629510361811] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The promotion of health checks for adults with learning disabilities in England is government policy based on the need to address lack of access to healthcare services and poor health outcomes for this group of citizens. This article reports the findings of a scoping review of the literature carried out in 2009 to explore the implications of a national system of health checks for the work of practitioners in social care services. The review found little in the research literature relevant to social care practice and concluded that there is a need to consider the possible roles of social care staff in initiating health checks; their possible involvement in decision making around issues of consent; social care practice in recording and implementing the recommendations of such checks; possible roles as escorts, chaperones and supporters with communications; and the presence of regulatory scrutiny of their participation in this activity.
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Haveman M, Heller T, Lee L, Maaskant M, Shooshtari S, Strydom A. Major Health Risks in Aging Persons With Intellectual Disabilities: An Overview of Recent Studies. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2010. [DOI: 10.1111/j.1741-1130.2010.00248.x] [Citation(s) in RCA: 146] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Lin JD, Hsu SW, Yen CF, Chou YT, Wu CL, Chu CM, Loh CH. Roles of General Practitioners in the Provision of Health Care Services for People with Intellectual Disabilities: A National Census in Taiwan. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2009. [DOI: 10.1111/j.1468-3148.2009.00523.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lindsay J, Crocker A, Browne P, Hassan D, Jackson AJ. Provision of Appropriate Eye Care Services for Adults with Learning Disabilities: the Experience of a Specialist Multi-Professional Visual Assessment Clinic in Northern Ireland. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/13882350600805753] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Harries J, Guscia R, Nettelbeck T, Kirby N. Impact of additional disabilities on adaptive behavior and support profiles for people with intellectual disabilities. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2009; 114:237-253. [PMID: 19642707 DOI: 10.1352/1944-7558-114.4.237-253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Accepted: 12/13/2008] [Indexed: 05/28/2023]
Abstract
Numerous researchers have reported a high incidence of additional disabilities coexisting with intellectual disabilities. Although an intuitive link can be made between the existence of multiple disabilities and greater need for support, little has been reported about this relationship. Using measures of adaptive functioning and support needs, we examined the extent to which adaptive and challenging behaviors and consequent support needs (including medical) were impacted by the presence and severity of additional disabilities for individuals with intellectual disabilities. Results show that adaptive behaviors and support needs were meaningfully related to the number and severity of additional disabilities present, whereas this was not so for challenging behaviors. Findings are discussed in terms of contemporary models of disability and functioning.
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Affiliation(s)
- Julia Harries
- University of Adelaide, school of Psychology, Adelaide, SA 5005, Australia.
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Gibbs M, Priest H. Exploring the physical health needs of people with learning disabilities: facilitation student engagement in learning, using Kolb's experiential learning cycle. Nurse Educ Pract 2009; 10:115-8. [PMID: 19482549 DOI: 10.1016/j.nepr.2009.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Revised: 03/31/2009] [Accepted: 04/21/2009] [Indexed: 10/20/2022]
Abstract
Using Kolb's experiential learning cycle as a framework, this paper will describe the facilitation of an experiential learning journey by a small group of learning disability nursing students in the UK, studying the physical health care needs of people with learning disabilities. Highlighted are the problems faced by people with learning disabilities in accessing primary health care services and some of the policy drivers for these services. This is then followed by an account of an educational process designed both to support learning about physical health and to enhance engagement and motivation of learning disability nursing students.
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Affiliation(s)
- Mike Gibbs
- School of Nursing and Midwifery, Keele University, Newcastle Road, st4 6qg, Staffs, United Kingdom.
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41
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Minnes P, Steiner K. Parent views on enhancing the quality of health care for their children with fragile X syndrome, autism or Down syndrome. Child Care Health Dev 2009; 35:250-6. [PMID: 19228158 DOI: 10.1111/j.1365-2214.2008.00931.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND International research in recent years has begun to focus on the medical problems of individuals with intellectual disabilities and on family stress in accessing health services for persons with developmental disabilities. Less is known about the needs of individuals in different diagnostic groups, or about their experiences of systems of care. Therefore, we report the results of focus groups with parents of children or adults with fragile X syndrome, autism or Down syndrome. METHODS Semi-structured group interviews with parents of children, youth or adults from each of three diagnostic groups probed perceptions of challenges and successes in obtaining and negotiating healthcare services in Ontario, Canada. RESULTS Parents described diverse barriers to care, the need for advocacy in securing services, perceptions of service delivery and the role of healthcare professionals in regulating access to a wide range of services. Diagnostic services represented one area of central concern to parents from all three groups. DISCUSSION Focus group data yielded a wide range of concerns. Suggestions for enhancing the system included expanding syndrome-specific education for medical students and health professionals and creating a centre that could offer service-related information for parents.
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Affiliation(s)
- P Minnes
- Department of Psychology, Queen's University, ON, Canada.
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Balogh R, Ouellette-Kuntz H, Bourne L, Lunsky Y, Colantonio A. Organising health care services for persons with an intellectual disability. Cochrane Database Syst Rev 2008:CD007492. [PMID: 18843752 DOI: 10.1002/14651858.cd007492] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND When compared to the general population, persons with an intellectual disability have lower life expectancy, higher morbidity, higher rates of unmet health needs, and more difficulty finding and getting health care. Organisational interventions are used to reconfigure the structure or delivery of health care services and may prove useful to decrease the noted disparities. OBJECTIVES To assess the effects of organisational interventions for the mental and physical health problems of persons with an intellectual disability. SEARCH STRATEGY We searched the Cochrane Effective Practice and Organisation of Care Group specialised register (no year restriction), MEDLINE, EMBASE, CINAHL, other databases from January 1990 to April 2006 reference lists of included studies, and we consulted experts in the field. SELECTION CRITERIA Randomised controlled trials, controlled clinical trials, controlled before and after studies and interrupted time series of organisational interventions aimed at improving care of mental and physical health problems of adult persons with an intellectual disability. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed study quality. Missing data were requested from authors of included studies. MAIN RESULTS Eight studies met the selection criteria: six were randomised controlled trials, one was a controlled before and after study, and one was an interrupted time series. In general the studies were of acceptable methodological quality. The included studies investigated interventions dealing with the mental health problems of persons with an intellectual disability, none focused on physical health problems. Three of the studies identified effective organisational interventions and five showed no evidence of effect. Only two studies were similar enough to analyse using a meta-analysis. In the pooled analyses 25 participants received assertive community treatment and 25 received standard community treatment. Results from measures of function, caregiver burden and quality of life were non-significant. AUTHORS' CONCLUSIONS There are currently no well designed studies focusing on organising the health services of persons with an intellectual disability and concurrent physical problems. There are very few studies of organisational interventions targeting mental health needs and the results of those that were found need corroboration. There is an urgent need for high quality health services research to identify optimal health services for persons with an intellectual disability and concurrent physical problem.
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Affiliation(s)
- Robert Balogh
- Graduate Department of Rehabilitation Science, University of Toronto, 160-500 University Ave, Toronto, Ontario, Canada, M5G 1V7.
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Griffiths P, Bennett J, Smith E. The size, extent and nature of the learning disability nursing research base: a systematic scoping review. Int J Nurs Stud 2008; 46:490-507. [PMID: 18842263 DOI: 10.1016/j.ijnurstu.2008.05.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Revised: 05/20/2008] [Accepted: 05/31/2008] [Indexed: 11/15/2022]
Abstract
BACKGROUND A research base should be of sufficient quality and quantity to inform nursing practice. It must allow nurses to access information about clients' needs and to identify effective strategies for meeting those needs. This paper presents the findings of a scoping review of 'learning disability nursing research'. The review aimed to determine whether there is a research base sufficient to support learning disability nursing practice. METHOD We undertook searches of the Cochrane Library and electronic databases (Medline, Psychinfo, Embase, CINAHL and British Nursing Index) for the years 1996-2006. Full references and abstracts were downloaded for papers returned. Papers considered relevant to the topic of the review were organised into three categories according to whether the main focus of the research was people with learning disabilities, carers or family members, or nurses. For each paper, information about the locality of the research, the topic of the research, design/method and sample size was extracted. FINDINGS We identified 180 relevant research studies, most of which made use of convenience samples of less than one hundred people. Very few studies evaluated the clinical impact of nursing interventions or the delivery of care by learning disability nurses. A small number of studies examined the impact or patient experiences of nurse-led interventions. These tend to small-scale evaluations of new service initiatives, such as the management of behavioural problems. Overall there was an absence of strong evidence about the effectiveness of specific nursing interventions. CONCLUSIONS The extent of learning disability nursing research is limited in quantity and it is difficult to draw comparisons across research studies. Much of the available evidence is drawn from small-scale evaluations; which may provide useful guidance and inspiration for service development but do not, in themselves, constitute a sufficient body of research evidence to support learning disability nursing practice.
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Affiliation(s)
- Peter Griffiths
- King's College London, National Nursing Research Unit, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, United Kingdom.
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Kran BS, Wright DW. A telephone survey of low vision services in U.S. schools for the blind and visually impaired. OPTOMETRY (ST. LOUIS, MO.) 2008; 79:378-390. [PMID: 18577495 DOI: 10.1016/j.optm.2007.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Revised: 08/22/2007] [Accepted: 11/01/2007] [Indexed: 05/26/2023]
Abstract
The scope of clinical low vision services and access to comprehensive eye care through U.S. schools for the blind and visually impaired is not well known. Advances in medicine and educational trends toward inclusion have resulted in higher numbers of visually impaired children with additional cognitive, motor, and developmental impairments enrolled in U.S. schools for the blind and visually impaired. The availability and frequency of eye care and vision education services for individuals with visual and multiple impairments at schools for the blind is explored in this report using data collected in a 24-item telephone survey from 35 of 42 identified U.S. schools for the blind. The results indicate that 54% of the contacted schools (19) offer clinical eye examinations. All of these schools provide eye care to the 6 to 21 age group, yet only 10 schools make this service available to children from birth to 3 years of age. In addition, two thirds of these schools discontinue eye care when the students graduate or transition to adult service agencies. The majority (94.7%) of eye care is provided by optometrists or a combination of optometry and ophthalmology, and 42.1% of these schools have an affiliation with an optometric institution. When there is a collaborative agreement, clinical services for students are available more frequently. The authors find that questions emerge regarding access to care, identification of appropriate models of care, and training of educational/medical/optometric personnel to meet the needs of a very complex patient population.
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Affiliation(s)
- Barry S Kran
- New England College of Optometry, Boston, MA 02115, USA.
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Hild U, Hey C, Baumann U, Montgomery J, Euler HA, Neumann K. High prevalence of hearing disorders at the Special Olympics indicate need to screen persons with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2008; 52:520-528. [PMID: 18410317 DOI: 10.1111/j.1365-2788.2008.01059.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Persons with intellectual disabilities (ID) are at increased risk for hearing impairment which often remains undetected. If left untreated, such hearing impairments may worsen the social and communicative problems of these persons. The aims of this study are to determine the prevalence of hearing impairment, to specify type and degree of hearing loss, and to evaluate the sensitivity and specificity of the screening in this population. METHODS During the German Special Olympics Summer Games 2006, 552 athletes with ID had their hearing screened according to the international protocol of Healthy Hearing, Special Olympics. This screening protocol includes otoscopy, measurement of distortion product otoacoustic emissions, and - if necessary - tympanometry and pure tone audiometry (PTA) screening at 2 and 4 kHz. Additionally, 195 athletes underwent a full diagnostic PTA. The results of the screening and diagnostic PTA were compared. RESULTS Of the 524 athletes who completed the screening protocol, 76% passed and 24% failed it. Ear wax was removed in 48% of all athletes. 42% of the athletes were recommended to consult an otolaryngologist or an acoustician. Of the 99 athletes whose screening-based suspicion of a hearing loss was confirmed with diagnostic PTA, 74 had an undetected hearing loss. The correlation (Cramer's V) between screening and diagnostic PTA was .98. The sensitivity of the screening was 100% and the specificity 98%. DISCUSSION The screening reliably detects hearing disorders among persons with ID. The prevalence of hearing impairment in this population is considerably higher than in the general population, and the proportion of undetected hearing impairments is large, even among people with only mild and moderate ID, as examined in this study. Therefore, a screening is highly recommended, and special attention from caregivers and professionals as well as regular hearing assessment and standard therapy programmes are required for persons with ID.
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Affiliation(s)
- U Hild
- Faculty of Medicine, University of Utrecht, Utrecht, The Netherlands.
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Starr JM, Marsden L. Characterisation of user-defined health status in older adults with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2008; 52:483-489. [PMID: 18341524 DOI: 10.1111/j.1365-2788.2008.01051.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Older adults with Intellectual Disabilities (ID) have an excess disease burden that standard health assessments are designed to detect. Older adults with ID have a broader concept of health with dimensions of well being in addition to absence of disease in line with the World Health Organization's health definition. We sought to characterise user-defined health status in a sample of older adults with ID. METHODS We administered a user-led health assessment to 57 adults with ID aged 40 years and over. Cluster analysis on user-defined health themes of participation, nutrition and hygiene/self-care identified clear separation of participants into a healthier and a less healthy group. RESULTS Disease burden (P = 0.002) and medication use (P = 0.003) were greater in the less healthy group. The healthier group were taller (P = 0.005), stronger (P = 0.005) and had better vision (P < 0.001) than the less healthy group. Constipation (P = 0.014), urinary incontinence (P < 0.001) and faecal incontinence (P < 0.001) were commoner in the less healthy group. There were few significant differences between health groups on the majority of standard physical-examination items. CONCLUSIONS There is considerable overlap between user-defined health and that assessed by standard instruments. In addition, user-defined health encompasses aspects of physical fitness not captured by traditional disease-based health models.
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Affiliation(s)
- J M Starr
- Geriatric Medicine Unit, Edinburgh University, Edinburgh, UK.
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O’Regan P, Drummond E. Cancer information needs of people with intellectual disability: A review of the literature. Eur J Oncol Nurs 2008; 12:142-7. [DOI: 10.1016/j.ejon.2007.12.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Revised: 11/22/2007] [Accepted: 11/26/2007] [Indexed: 11/27/2022]
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Fender A, Marsden L, Starr JM. Assessing the health of older adults with intellectual disabilities: a user-led approach. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2007; 11:223-39. [PMID: 17846046 DOI: 10.1177/1744629507080785] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Older adults with intellectual disability are at increased risk of a wide range of health problems. Hitherto, methods to assess these problems have been healthcare-professional-led and largely based on traditional medical models. Following a literature review and focus group work we produced a user-led health assessment that was feasible and acceptable. The assessment was administered to 57 adults with a wide range of intellectual disability aged 40 years and over, living in the community. The assessment took a median of 21 minutes to administer and covered user-led themes of participation/ability, nutrition and hygiene/self-care. A principal component representing a user-led general health measure correlated positively with the number of health problems (rho = 0.54, p < 0.001) and the number of drugs (rho = 0.55, p < 0.001). Further studies using such user-led assessments are needed to assess whether they can have a wider application.
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Gilbert T, Wilkinson T, Crudgington S. Supporting people with intellectual disability in the cancer journey: The ‘Living with cancer’ communication pack. Eur J Oncol Nurs 2007; 11:357-61. [PMID: 17291830 DOI: 10.1016/j.ejon.2006.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Revised: 11/21/2006] [Accepted: 12/20/2006] [Indexed: 11/24/2022]
Affiliation(s)
- Tony Gilbert
- Faculty of Health and Social Work, University of Plymouth, PL4 8AA, UK.
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50
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Crawford H, Leslie P, Drinnan MJ. Compliance with Dysphagia Recommendations by Carers of Adults with Intellectual Impairment. Dysphagia 2007; 22:326-34. [PMID: 17701245 DOI: 10.1007/s00455-007-9108-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Health risks associated with dysphagia in adults with intellectual impairment are well documented. There is little research into compliance with dysphagia recommendations in environments where care is provided for adults with intellectual impairment. This is a pilot study into carer compliance with Speech-Language Pathology recommendations. We aimed to investigate the level of compliance with dysphagia recommendations in day centers and the factors that might affect compliance using a questionnaire. Twenty-seven clients were observed. Results showed an overall high level of compliance with recommendations (82%), with figures ranging from 64% compliance with appropriate utensils to 100% with direct support recommendations. Areas of noncompliance were evident, with level of dependence of clients and training of carers being key issues. Implications for practitioners are discussed.
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Affiliation(s)
- Hannah Crawford
- Tees, Esk and Wear Valleys NHS Trust, Freeman Hospital, Newcastle upon Tyne, UK.
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