Characteristics of Medicare Beneficiaries With Intellectual or Developmental Disabilities

Health inequities among persons with disabilities: a global scoping review

Background and objective

Approximately 16% of the global population, or 1.3 billion individuals, live with disabilities, facing increased health risks. Despite international and national policies affirming the rights of persons with disabilities, healthcare disparities persist, with studies revealing higher rates of unmet medical needs, avoidable deaths, and dissatisfaction with healthcare services among this population. This scoping review aims to provide a comprehensive overview of health inequities experienced by individuals with disabilities globally.

Methods

A rapid scoping review methodology was employed to systematically search and analyze quantitative evidence on health inequities. Electronic searches were conducted in CINAHL, MEDLINE, and PsycINFO databases, supplemented by manual searches of reference lists. The selection criteria for articles in this study were as follows: (a) publication between 2011 and 2022, (b) written in English, (c) published in a peer-reviewed scholarly journal, and (d) a quantitative comparison of health inequities between persons with and without disabilities.

Results

A total of 363 scholarly works were initially identified, with 51 meeting the inclusion criteria after rigorous screening. In the course of our review, our team identified three overarching themes of health inequity, encompassing (a) access to healthcare and resources, (b) morbidity, mortality, & risk factors, and (c) social determinants of health. These studies collectively reveal disparities in healthcare access, utilization, and outcomes among persons with disabilities, highlighting the urgent need for targeted interventions to address systemic barriers and promote equitable healthcare provision.

Conclusion

This review underscores the challenges faced by individuals with disabilities in accessing quality healthcare and imperative for concerted efforts to advance health equity.

Diverse perspectives on supporting the health and wellness of people with intellectual and developmental disabilities

BACKGROUND

Persons with intellectual and/or developmental disabilities (IDD) are a growing population, frequently living with complex health conditions and unmet healthcare needs. Traditional clinical practice and research methods and measures may require adaptation to reflect their preferences.

OBJECTIVE

The perspectives of people with IDD, caregivers/partners, and clinicians were obtained to provide insight into factors contributing to the health and wellness of people with IDD. These, in turn, suggest opportunities for improvements in clinical training and care, and considerations for enhancing research methods and measures.

METHODS

An exploratory design, participatory methods, abductive qualitative approach and thematic analysis were employed. Interview data were obtained in twelve focus groups with people with IDD (n = 25), caregivers/partners (n = 21), and clinicians (n = 27). Particular attention was paid to supporting attendees in focus group participation, with adaptations and accommodations made for communication preferences, and graphic illustrations were provided.

RESULTS

Themes emerging across attendee categories that reflect factors contributing to health and wellness for people with IDD include: (1) making healthy choices; (2) participating in everyday activities; (3) benefitting from natural supports (e.g., family, friends, peers); and (4) accessing skilled professional supports (e.g., healthcare provision and payment).

CONCLUSIONS

Study findings underscore factors related to supporting health and wellness for people with IDD and suggest the importance of autonomy, accessibility, healthy relationships, self-advocacy, and tailored clinical care. People with IDD can be actively engaged throughout the research enterprise to ensure the relevance, acceptability, and accessibility of research methods and measures; promote inclusiveness; and address health disparities.

Health care transition quadruple aim outcomes for IDD: Scoping review

Purpose

Structured HCT models addressing planning, transfer, and integration into adult care for adolescents and young adults with childhood-acquired chronic conditions are becoming more prevalent. However, consensus on outcome measures to assess health care transition (HCT) interventions particularly for intellectual and developmental disabilities (IDD) population is lacking. This scoping review identified potential HCT outcome measures for young adults (aged 18-26) with IDD using the Quadruple Aim Framework.

Methods

On August 6, 2021 and April 27, 2023, Medline Ovid, Embase, Web of Science, PsycINFO, and Cochrane databases were searched using the terms "young adult," "intellectual disability," "developmental disability, "cognitive dysfunction," "autism," "cerebral palsy," "spina bifida," and "transition to adult care." Searches were limited to publications in English and published from 2000 to present. Observational and experimental (qualitative or quantitative) studies were included if participants were young adults (median/mean ages 18-26) with IDD (Autism, cerebral palsy, Down syndrome, spina bifida, or other IDD-related conditions) and study outcomes addressed one of the Quadruple Aim domains (population health, patient/family experience, cost/utilization, and healthcare provider/caregiver experience). Studies were excluded if participants had attention deficit/hyperactivity disorder or learning disability only, if outcomes were primarily educational or vocational, or if publications were reviews, abstracts, or not in English.

Results

One hundred and three articles were included data extraction. Articles were categorized under the Quadruple Aim domains: Population Health (43), Patient/Caregiver Healthcare Experience included (23), Cost/Utilization (24), and Healthcare Provider/Caregiver Experience (15). Most articles were observational and utilized a variety of assessments or internally developed questions as measures.

Conclusions

While studies describing HCT outcomes for the IDD population are limited and measures are inconsistent, studies pertaining to Quadruple Aim outcomes identified in this review can further direct efforts towards consensus and standardization of HCT outcome measures to address the needs of individuals with IDD, their families, and caregivers/providers.

Co-Occurring Mental Illness and Behavioral Support Needs in Adults with Intellectual and Developmental Disabilities

People with intellectual and developmental disabilities (IDD) have higher incidences of mental health conditions and behavioral support needs than people without IDD but may not receive needed care from community providers. We examined rates of co-occurring conditions in a representative sample of adults with IDD who use state funded services in Virginia. Using data from two datasets, we identified four categories of mental health and behavioral conditions. We used these categories to examine differences in individual- and system-level factors in people with and without co-occurring conditions. We found high rates of co-occurring conditions in our sample. We found important disability factors and system-level characteristics that were associated with having a diagnosed mental health condition or behavioral support needs. Differing patterns of diagnosis and treatment for co-occurring conditions suggests more work needs to be done to support people with IDD and co-occurring mental health conditions living in the community.

Freeman Center for intellectual and developmental disabilities: Patient-centered interdisciplinary care

Objectives

Adults with intellectual or developmental disabilities (IDD) face substantial barriers to accessing high-quality, patient-centered care. This paper describes the development and evolution of the Freeman Center, an integrated, interdisciplinary center developed using feedback from adults with IDD and their family members.

Methods

We evaluated the reach of the Freeman Center services and described the patient population.

Results

As of November, 2022, 1068 patients were seen at the Freeman Center. These patients represent about 5 % of all people with IDD in Hamilton County Ohio, where the Freeman Center is located. On average in 2022, the Freeman Center provided approximately 380 primary care visits, 47 psychiatry visits, and 85 combined primary care and psychiatry service visits per month.

Conclusions

Patient demographic characteristics are largely consistent with the general population of Hamilton County, indicating patients are representative of the county the clinic primarily serves. Further work is needed to evaluate patient outcomes at the Freeman Center.

Invisible populations: Who is missing from research in intellectual disability?

It is estimated that approximately 41% of adults with intellectual and developmental disability (IDD) are served through the developmental disabilities (DD) system in the US. The remaining 59% include individuals who meet diagnostic criteria but are not actively receiving paid services or may not be known to the DD system. Scholars have referred to this group as the "hidden majority." Very little is known about the health and well-being of these adults. It remains to be seen if the hidden majority is comparably susceptible to mental health difficulties, given how little is known about this population by DD systems. The purpose of this manuscript is to highlight where one may identify individuals belonging to this hidden population and how researchers might effectively recruit from this group so as to ensure more representative samples of all people with IDD.

Nurses' attitudes and emotions toward caring for adults with intellectual disability: An international replication study

PURPOSE

Negative nurse attitudes and emotions toward caring for adults with intellectual disability have been implicated as a contributing factor to the cascade of health disparities faced by this population. The purpose of this study was to identify influencing factors of nurses' attitudes and emotions toward caring for adults with intellectual disability that transcend national borders and differing systems of care.

METHODS

This cross-sectional correlational predictive replication study used an online electronic survey with a snowball sample of 115 Australian nurses, from March to August 2020.

RESULTS

Nurses' attitudes toward adults with intellectual disability were significantly less positive compared to adults without intellectual disability, and nurses' beliefs about the quality of life of adults with intellectual disability predicted nurses' attitudes, replicating findings of the USA study. The frequency of both the professional and personal contact was associated with positive and negative emotions in both countries, however no consistent predictive pattern was evident.

CONCLUSIONS

Our findings suggest that worldwide, there is room for improvement in nurses' attitudes and emotions toward this underserved group. Future research should investigate the role of nurses' beliefs about quality of life of adults with intellectual disability for potential interventions to improve nurses' attitudes toward care.

CLINICAL RELEVANCE

Assisting nurses to identify misconceptions about the quality of life of adults with intellectual disability is suggested as an intervention to improve nurses' attitudes toward caring for adults with intellectual disability.

Food insecurity of people with disabilities who were Medicare beneficiaries during the COVID-19 pandemic

BACKGROUND

During the COVID-19 pandemic, 54 million people in the United States were food insecure (2020). People with disabilities (PWD) who were Medicare beneficiaries were especially vulnerable to food insecurity prior to the pandemic.

OBJECTIVE

The aim of this study was to explore COVID-19 pandemic food insecurity among PWD who were Medicare beneficiaries.

METHODS

We conducted a secondary analysis of the United States Census Bureau COVID-19 Household Pulse Survey data about the food security of 70,171 PWD who were Medicare beneficiaries (under 65), and a comparison group of 1.1 million non-Medicare beneficiaries (under 65). Data were weighted using frequency person-weights.

RESULTS

Only 44.3% of PWD who were Medicare beneficiaries had enough of the foods they wanted to eat during the pandemic. Reasons for food insecurity included: could not afford to purchase more food (56.9%); stores did not have the food they wanted (31.4%); afraid to go out to get more food (30.0%); could not get out to get more food (21.5%); and could not get food delivered (8.5%). PWD who were Medicare beneficiaries were more likely to be food insecure than non-Medicare beneficiaries. There were also disparities in food insecurity among PWD who were Medicare beneficiaries themselves with household size, Medicaid beneficiaries, gender, race, education, martial status, household income, and Supplemental Nutrition Assistance Program (SNAP) all impacting food security.

CONCLUSIONS

A multipronged approach that addresses not only food-related public health, but also other systems and structures is critical to end food insecurity.

Community-Engaged Research to Address Health Disparities of Indigenous Women With Disabilities

INTRODUCTION

To address health disparities among underserved populations, occupational therapists can participate in community-engaged research and practice to improve access to preventive health services.

METHODS

This study used grounded theory and participant observation approaches to identify lessons learned from a community-engaged research project to improve cancer screening rates for Indigenous women with an intellectual and/or developmental disability (IDD). Audio recordings of meetings with a community advisory board (AB) were analyzed with an inductive coding approach, and results were member checked with AB members. The AB members (N = 8) were involved in statewide Indigenous health, cancer, and disability activities. Six of the eight AB members identified as Indigenous.

RESULTS

Key themes highlighted within the Indigenous research framework included reflection, relationship building, project planning, and project execution. Results of this phase of the research project highlight the importance of codesigning research projects with Indigenous communities.

CONCLUSION

The findings have limited transferability to other research contexts. However, this study highlights the need for future research on best practices for occupational therapists to participate in community-engaged research projects to address health disparities in underserved populations, such as Indigenous women with IDD.

Testing a Wellness Indicators Measure for People with Intellectual and Developmental Disabilitiesa

BACKGROUND AND PURPOSE

People with intellectual and developmental disabilities (IDD) often have health and wellness issues that are not as good as people without disabilities. States are required to monitor health and wellness for people with IDD who use many disability services. However, there are few ways to monitor wellness between states or at different points in time. In this study, we share a new model that states may use to monitor wellness of people with IDD.

METHODS

We used data from a survey called the National Core Indicators (NCI) to develop this model. First, we developed the model using our state's data. Then, after we found a model that worked well, we tested that model using the National Core Indicators from the entire U.S.

RESULTS

Our final model worked well in both our state NCI data and the national NCI data. This is important because policies at both levels can affect the services that people with disabilities can use. Our model had three parts: heart health, mental health, and behavioral wellness. These are described more in the paper. We also used statistics to test some factors that might predict outcomes related to heart health, mental health, and behavioral wellness. Age, sex, where someone lives, and level of intellectual disability were all good predictors of all three categories of wellness that we studied.

IMPLICATIONS

The model of wellness that we developed worked well but should be tested using data from other individual states. It is very important to know about health and wellness right now since the services people with disabilities can use are changing in many states. We think our model can help planners and advocates understand how services affect wellness in a way that is easy to compare from state to state and at different points in time.

Looking across health and healthcare outcomes for people with intellectual and developmental disabilities and psychiatric disorders: population-based longitudinal study

BACKGROUND

Intellectual and developmental disabilities (IDDs) and psychiatric disorders frequently co-occur. Although each has been associated with negative outcomes, their combined effect has rarely been studied.

AIMS

To examine the likelihood of five negative health and healthcare outcomes for adults with IDD and mental health/addiction disorders (MHAs), both separately and together. For each outcome, demographic, clinical and system-level factors were also examined.

METHOD

Linked administrative data-sets were used to identify adults in Ontario, Canada, with IDD and MHA (n = 29 476), IDD-only (n = 35 223) and MHA-only (n = 727 591). Five outcomes (30-day readmission, 30-day repeat ED visit, delayed discharge, long-term care admission and premature mortality) were examined by logistic regression models with generalised estimating equation or survival analyses. For each outcome, crude (disorder groups only) and complete (adding biosocial covariates) models were run using a general population reference group.

RESULTS

The IDD and MHA group had the highest proportions across outcomes for both crude and complete models. They had the highest adjusted ratios for readmissions (aOR 1.93, 95%CI 1.88-1.99), repeat ED visit (aOR 2.00, 95%CI 1.98-2.02) and long-term care admission (aHR 12.19, 95%CI 10.84-13.71). For delayed discharge, the IDD and MHA and IDD-only groups had similar results (aOR 2.00 (95%CI 1.90-2.11) and 2.21 (95%CI 2.07-2.36). For premature mortality, the adjusted ratios were similar for all groups.

CONCLUSIONS

Poorer outcomes for adults with IDD, particularly those with MHA, suggest a need for a comprehensive, system-wide approach spanning health, disability and social support.

A Call for Better Data on Prevalence and Health Surveillance of People With Intellectual and Developmental Disabilities

The U.S. approach to the health of people with intellectual and developmental disabilities (IDD) is fraught with paradox. The health of this population has been of longstanding concern, yet we understand their health less well than many other groups. The U.S. spends much more per person on the well-being of people with IDD compared to the general population, yet the outcomes of those expenditures are disappointing and include significant preventable health disparities. Even as expectations for people with IDD have changed to include better health and greater participation in their communities, eligibility for services that support these outcomes is rooted in expectations of dependence and poverty. This article is a call for better data that considers a series of questions to provide context for understanding the need and directions for better health surveillance of people with IDD.

Technology Tools: Increasing Our Reach in National Surveillance of Intellectual and Developmental Disabilities

Challenges in collecting comprehensive health surveillance data on people with intellectual and developmental disabilities (IDD) are numerous. A number of important issues and strategies are discussed in the articles contained in this special issue of Intellectual and Developmental Disabilities. In this article, we focus on the advances and tools available in the area of technology. We explore a number of possible sources including accessing big data such as analyzing health information contained in Medicaid and Medicare health databases. We also discuss some of the possibilities afforded to us by complementing Medicaid/Medicare database information with health information available in the myriad of electronic health records. Lastly, we explore other technologies available that might yield valuable health supports and information, including wearable devices, remote supports and other smart home technologies, telehealth and telepsychiatry, as well as looking at ways to access other technologies that collect health information (e.g., glucometer, health apps, connected exercise devices, etc.).