Suchergebnisse

AbstractThe authors sought to create a demographic, socioeconomic, and health‐related profile of older (40+) Canadian adults with developmental disabilities (DD) residing in their communities, and to enhance current knowledge of their unmet health and social support services needs. They provide a secondary analysis of cross‐sectional data from the 2001 and 2006 Participation and Activity Limitation Surveys (PALS). The study population comprised PALS respondents who: (a) were at least 40 years of age at the time of the survey and (b) were reported having a DD. Weighted data were used to describe and compare the profiles of the study population and the comparison group (PALS respondents age 40+ with other types of disability), and to estimate the prevalence of reported unmet healthcare and social support services needs. Logistic regression analyses determined the extent to which these needs affected the target population's overall health status. The data revealed that an estimated 136,570 Canadians age 15+ reported having a DD in 2006. Of these, 66,560 (48.7%) were at least 40 years of age. An estimated 47.7% of this population rated their overall health status as either fair or poor. The prevalence of reported unmet healthcare and social services needs decreased between 2001 and 2006 for both study groups, but it was still much higher for older individuals with DD than for the comparison group in 2001 and 2006. Controlling for the effects of all the other factors, the authors found that reported unmet needs did not significantly affect respondents' overall health status. The authors concluded that compared to Canadians with other types of disability, those with DD were more likely to report unmet healthcare and social support services needs. Further research is needed to explore policies and programs which support the healthy and active aging of this population.

AbstractBackgroundComplete physical examinations (CPE) can identify health disparities in persons with intellectual or developmental disabilities. The objective of this study was to determine and compare rates of CPE among Manitoba adults with and without intellectual or developmental disabilities over time and to identify factors that were associated with receiving a CPE.MethodA retrospective cohort study using linked administrative health and non‐health data from 1995 to 2015 was conducted. Poisson and logistic regression were used to calculate CPE rates and examine factors associated with CPE.ResultsThe rates of CPE are decreasing over time and are higher among Manitobans with an intellectual or developmental disability. Characteristics such as being male, living rurally, low socioeconomic status, and high continuity of care led to lower odds of receiving a CPE.ConclusionsThe current state of CPE provision to adults with intellectual or developmental disabilities in Manitoba is encouraging but needs improvement.

BackgroundThis paper reviews what is currently known about mortality among Canadians with intellectual and developmental disabilities and describes opportunities for ongoing monitoring.MethodsIn‐hospital mortality among adults with intellectual and developmental disabilities in Ontario was examined using hospital data. Mortality was compared between age‐, sex‐ and residence area‐matched groups of Manitobans with and without intellectual and developmental disabilities using linked administrative data. A retrospective cohort study of mortality among individuals with intellectual and developmental disabilities in a region of Ontario focused on measuring excess mortality and risk factors.FindingsThere is evidence of excess mortality in persons with intellectual and developmental disabilities in Canada. Some of the excess is attributable to comorbidities that are more common in this population. Women may have a greater risk of death than men. Excess mortality occurs at all ages but is more pronounced in early life.DiscussionHigh‐quality ongoing monitoring of mortality among individuals with intellectual and developmental disabilities is possible in Canada. Examination of sex differences should be a priority.

Many carers spend money out of their own pockets on the care-related needs of their family members or friends, and this spending may expose carers to a higher risk of financial hardship. Using data from a nationally representative sample of family carers drawn from Statistics Canada's 2012 General Social Survey on Caregiving and Care Receiving, we find that nearly one in five carers reports experiencing financial hardship. The results from multivariate logistic regression analysis show that care-related out-of-pocket expenditures are significant predictors of financial hardship. The results suggest establishing personal financial planning strategies and public policies to minimise the risk of incurring financial hardship due to care-related out-of-pocket expenditures.

Worldwide, the community transition process away from institutions has increased in the past 30–50 years among persons with severe intellectual and developmental disabilities. This process, also known as "deinstitutionalization", could potentially impact problem behaviors and communication. This study examined the impacts of community transitions on behavioural and communication outcomes in Canadians with intellectual and developmental disabilities. Data were collected using the Comprehensive Health Assessment Program and medical chart reviews. Descriptive, aggregate-level, and individual-level analyses were conducted for 32 adults who transitioned to community living. Descriptive analyses and the McNemar Chi-Square Test were conducted. Following community transitions, the study group experienced a significant decrease in problem behaviours and changes in communication. The study findings suggest that deinstitutionalization could provide effective strategies for addressing problem behaviors and fostering improvements in communication, promoting the well-being and quality of life of persons with intellectual and developmental disabilities.

AbstractThe authors examined the health‐related literature on aging and intellectual disabilities (ID) published since 1999, with specific focus on examining findings on age‐associated health risk factors, such as cardiovascular, gastrointestinal, and musculoskeletal system health issues, and age‐related oral health. They also examined studies of lifestyle health risks, primarily the contributions to overweight or obesity. Although the review revealed varying differences in the prevalence of health risk factors, significant evidence is emerging that cardiovascular disease is as prevalent among people with ID and is as common a cause of death as in the general population. However, the review showed that the variations in prevalence were culturally dependent. Digestive system problems were evident with high occurrence rates of helicobacter pylori, gastroesophageal reflux disease, and constipation. The review revealed a growing body of work on health risk factors, such as overweight and obesity, which are often linked to the onset of a variety of diseases and impairing conditions. Healthier lifestyles, better nutrition and more exercise, and greater surveillance of health risks were seen as ways to improve the health status of aging adults with ID.

BackgroundNo standardized tool is used in Canada for comprehensive health assessments of adults with intellectual disabilities. This study was conducted to determine the feasibility of implementing the Comprehensive Health Assessment Program (CHAP) in Manitoba, Canada.MethodThis was a qualitative study using a purposive sample of physicians, nurse practitioners, support workers and families. Data were collected through individual interviews and focus groups and were analysed using content analysis.ResultsUse of the CHAP was perceived as beneficial for persons with intellectual disabilities. Improved continuity of care was of the reported benefits. Six barriers for the future implementation of the CHAP were identified including the time required to complete the CHAP, and the perceived lack of physicians' willingness to do comprehensive assessments.ConclusionThe future implementation of the CHAP was strongly supported. For its successful implementation, training of healthcare professionals and support staff and change in regulations and policies were recommended.

AbstractThe authors report on the outcome of a consultation workshop held in Iran, which focused on knowledge translation (KT) and intellectual and developmental disability (IDD). The goal was to learn more about the contextual factors that facilitate and impede KT in applications related to IDD in Iran. Forty‐six stakeholders participated, representing the perspectives of policy‐makers, administrators, parents, practitioners, and researchers. The authors introduced a conceptual framework for KT and assessed KT capacity using a validated tool. They facilitated discussions among stakeholder groups with respect to contextual facilitating and impeding factors, and suggested ways to improve IDD‐related KT activities in Iran. The authors found that all of the stakeholder groups highly valued research, but there were statistically significant differences among the participating stakeholder groups in acquiring, accessing, adapting, and applying research information to their practice. A number of factors, including the existing connections between parents and practitioners, could potentially facilitate the development of collaborative KT strategies. A lack of time, incentives, and resources were reported by all stakeholder groups as impeding factors for KT in IDD. The authors believe the researchers in Iran need to work closer with stakeholder groups to develop KT strategies with respect to IDD and thus achieve more effective dissemination of research findings that affect policy and practice.

AbstractObjectivesThe goals of this study were to examine and compare (a) the annual adult mortality rates and (b) the most commonly reported underlying causes of death between a cohort of Manitobans with intellectual and developmental disabilities (IDD) and a matched comparison group without IDD.MethodsUsing linked health and nonhealth administrative data, a cohort of Manitoba adults with IDD, aged 25–99 years in 2012, was identified. Each person in the study cohort was matched with three persons without IDD based on age, sex, region of residence, and morbidity level. The two groups were followed for three years (2013–2015). Crude annual adult mortality rates and avoidable premature mortality rates were calculated. The leading causes of death over the 3‐year study period were tabulated by ICD‐10 chapter. Coding of the underlying causes of death was reviewed.ResultsThe crude annual mortality rates for Manitoba adults with IDD were 1.8–2.4 times higher than those for the matched comparison group and remained stable over time. Disparities in mortality rates for the IDD cohort relative to the matched comparison group decreased with increasing age. No significant sex differences were found. The leading causes of death among the IDD cohort were diseases of the circulatory system, cancer, and diseases of the respiratory system. Avoidable premature deaths were 2.3–3.3 times more prevalent among Manitoba adults with IDD compared to the matched comparison group. An IDD diagnostic code was reported as cause of death in 2.11% of cases.ConclusionsThe excess mortality among adults with IDD should be monitored in Manitoba and all other jurisdictions and attention paid to the causes of death and their coding.

BackgroundLittle information exists on health of children with developmental disabilities (DDs) in the Canadian province of Manitoba.MethodThe present authors linked 12 years of administrative data and compared health status, changes in health and access to health and social services between children with (n = 1877) and without (n = 5661) DDs living in the province, matched by age, sex and region of residence.ResultsChildren with DDs were significantly more likely than children in the matched comparison group to die before the age of 17 and have a history of respiratory illness, diabetes and injury‐related hospitalizations. Children with DD also had significantly higher average number of ambulatory physician visits and higher rate of continuity of care.ConclusionsChildren with DDs had poorer health status than the matched comparison group. The health disparities experienced by children with DDs persisted over time. Further population‐based longitudinal research is needed in this area.

AbstractBackgroundWhile higher rates and earlier onset of frailty have been reported among adults with intellectual and developmental disabilities (IDD), research on how best to support these individuals is lacking.MethodAn international consultation relied on three consensus building methods: the Nominal Group Technique, an NIH consensus conference approach, and a Delphi survey.ResultsThere is agreement that person‐centered planning and aging in place should be guiding principles. Frailty must be considered earlier than in the general population with the recognition that improvement and maintenance are viable goals. Intersectoral collaboration is needed to coordinate assessments and actions. Safety and planning for the future are important planning considerations, as are the needs of caregivers. Ongoing research is needed.ConclusionThe statement offers guidance to respond to frailty among adults with IDD and fosters ongoing exchange internationally on best practice. As new evidence emerges, the statement should be revisited and revised.