Shifting Models of Welfare: Issues in Relocation from an Institution and the Organization of Community Living

An examination of the nutritional intake and anthropometric status of individuals with intellectual disabilities: Results from the SOPHIE study

The prevalence of obesity appears greater in people with intellectual disabilities than those in the general population. This study aimed to examine the nutritional intake and anthropometric status of individuals with intellectual disabilities. Participants aged 16-64 years were recruited from intellectual disability service provider organizations ( n = 131). Data were collected using questionnaires; 4-day food dairies and weight, height and waist circumference measurements. Participants' mean body mass index (BMI) was 29.4 kg/m² ± 6.1, 2.4% were underweight, 22.6% were normal weight, 28.2% were overweight and 46.8% were obese. Having a diagnosis of Down syndrome ( p = 0.03) was associated with increasing BMI. Increasing waist circumference was associated with increasing severity of ID ( p = 0.04). The mean-reported energy intake was 1890 kcal/day. Mean energy intakes from sugar, fat and saturated fat were above recommendations and few participants met micronutrient recommended daily amounts. This study highlights the alarming prevalence of overweight and obesity and poor diet quality of individuals with intellectual disabilities.

Activities of daily living and transition to community living for adults with intellectual disabilities

BACKGROUND

As adults with intellectual disability (ID) in Ireland move to the community from residential settings, the changed environment is intended to increase opportunities for occupational engagement, autonomy and social relationships. It is important to consider how increased resources and opportunities available within the community can be optimized to promote engagement and quality of life.

AIMS

This paper investigates if and how ADL and IADL performance of people ageing with ID is related to place of residence.

METHODS

ADL and IADL performance of adults with ID in Ireland across different living situations was analyzed using descriptive and bivariate analysis of data collected from the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS TILDA).

RESULTS

Greater ability to perform ADL and IADL was noted in those living in independent or community group home settings when compared to traditional residential settings. Place of residence was strongly related to ADL and IADL performance.

CONCLUSION AND SIGNIFICANCE

Given that people with ID will likely require physical and social supports to complete ADL and IADL when transitioning to community living from residential settings, an occupational justice perspective can inform occupational therapists working with people with ID, facilitating successful transitions to community living.

Snapshot of flexible funding outcomes in four countries

This article reviews social participation outcomes identified in discrete studies of flexible funding programmes across four countries. The outcomes of an Australian flexible funding support programme were studied in 2007; a study tour of independent living programmes was conducted in England and Scotland during 2005; Swedish co-operatives and government administrators providing personal assistance to live independently were visited in 2006 and Australian independent living support groups operating for over 20 years were visited in 2008. Fifty-six interviews were conducted with people with a disability, families, support services, government administrators and researchers. A structured interview schedule was used in the 2007 Australian study and a semi-structured format was used in all other studies. Notes from the interviews were reviewed for themes related to social participation and their contributing factors. Ecological systems theory was used to identify what factors from the micro to the macro system level facilitated or hindered social participation. The key finding is that flexible funding did result in a range of social participation activities in each setting studied. The studies also indicate that social participation increases when people have access to information and support services; can choose their individual workers and move to a new agency if need be; and have adequate resources to meet their needs. The cultural and political context plays a large part in determining these factors. The implications of this study are that adequate resources are needed and the complex systems impacting on flexible funding need to be understood to achieve the intended outcomes.

Known well by no-one: trends in the informal social networks of middle-aged and older people with intellectual disability five years after moving to the community

BACKGROUND

Informal relationships are central to conceptualisations of quality of life. Deinstitutionalisation studies consistently suggest a trend of increased contact with family and friends by people with intellectual disability (ID) following relocation from an institution to the community. In this study, changes in the nature of the informal relationships of residents 5 years after leaving an institution were examined.

METHOD

A sample of 24 participants was randomly selected from a group of 55 residents who moved to the community. Data were collected prior to leaving the institution, and 1, 3 and 5 years after the move, through interviews with staff, a telephone survey with 20 family members, and intensive case studies undertaken with a small purposive sub-sample of 11 residents.

RESULTS

Data indicated that: (i) residents did not form new relationships after relocation, (ii) the number of residents in regular touch with a family member decreased, and (iii) patterns of contact changed as residents aged. Some 62% of residents had no-one outside the service system who knew them well or monitored their well-being.

CONCLUSION

Services must take a more active role in supporting the development of relationships between individuals with ID, particularly those who are middle-aged or older, and people outside the service system, and in adapting to the changing capacity of ageing families.