Adults with Intellectual & Developmental Disabilities Flashcards
why are people w IDD living longer (3)
- improved medical care
- US public policy: education, setting of care/de-institutionalization
- advocacy: self & family/friends
what is the significance of how people w IDD age
premature aging
- accelerated problems at a higher rate (ie issues w vision, osteoporosis)
what is the significance of people w IDD experiencing health and healthcare disparities
leads to poor health outcomes
what are 5 systems that have health issues in IDD
- MSK
- metabolic
- cardiovascular & pulm
- GI and GU
- sensory (vision, hearing)
what are 5 health issues experienced in IDD
- obesity
- dental disease
- falls
- mental illness
- fatigue, poor sleep
what are 4 various MSK conditions that can develop over time in IDD
- hip dislocation
- patella alta
- spondylolysis
- cervical spine stenosis
what should be considered as contributing to MSK conditions that develop over time in IDD
impact of chronic abnormal joint biomechanics
what are 3 common MSK/ortho health issues in IDD
pain
dec bone mineral density
osteoporosis (inc vs gen pop)
what is the significance of MSK pain in IDD
often underreported/unrecognized
- IDD difficulty interpreting and communicating the pain
- dec access to providers who would recognize
what is a challenge with MSK health issues in IDD
proper screening/dx and treatment
- difficulty to get access
- difficult to lie still to be scanned
what screens for MSK/ortho health issues like osteoporosis in IDD
dual emission XR absoptiometry scan
what are 4 metabolic health issues in IDD
- metabolic syndrome - early onset
- DM
- coronary artery dz
- hypercholesteremia
what is the significance of metabolic health issues in IDD
can lead to death
what is the incidence of obesity in IDD
inc rates
- esp if + down syndrome, women + IDD
etiology of obesity in IDD
multifactorial:
- modifiable risk factors
- non modifiable (ie meds, mobility limitations)
- reliance on caregivers to move
what is the significance of obesity in IDD (2)
impacts development of metabolic syndrome
neg social stigma
what type of intervention is needed for obesity in IDD
multifactorial to treat multifactorial etiology
what are 3 cardiopulm health issues in IDD
- cardiovascular dz
- COPD
- other lung conditions (pneumonia & influenza)
what is the significance of cardiopulm health issues in IDD
significantly higher death rates compared to gen pop
what impacts the death rate d/t COPD or other lung conditions in IDD
33% in severe ID
50% in IDD institutions
what are 3 GI/GU health issues in IDD
- new or pre-existing incontinence (urinary, bowel, or both)
- inc mortality rate d/t bowel obstruction, perforated ulcers
- no regular cancer screening for colon, breast, prostate
what is the major issue with GI/GU health issues in IDD
undiagnosed, therefore untreated
what are 3 factors that impact GI/GU health issues in IDD
communication
cognition
interpretation of nociception
what sensory health issues are very prevalent in IDD (2 and related)
vision impairments more common vs gen pop
eye dz
what is the most common cause of vision impairments in IDD
uncorrected refractive errors (ie astigmatism, myopia, hyperopia)
what 2 vision impairments are there a high occurrence of in IDD
nystagmus
strabismus
what 3 eye diseases are common in IDD
cataracts
conjunctivitis
inflammatory conditions
what is the incidence of hearing issues in IDD
30% fail when screened
what organization provides most data to give insight into health issues in IDD
special olympics healthy athletes
what are 6 oral health issues in IDD
- OA of TMJ
- xerostomia (dry mouth)
- dental caries
- periodontal dz
- impaired chewing - esp w tooth loss
- tooth loss
what is the significance of dental caries in IDD
often underdiagnosed, or untreated or treated by extraction instead of fillings/root canals
what is the incidence of tooth loss in IDD
> 65yo w IDD, more likely to have lost all natural teeth vs gen pop
what is the significance of dental disease in IDD
directly impacts individuals overall systemic health and communication, taste, smell, smile, facial expressions
what is the incidence of falls and the significance
higher rate vs gen pop
higher rate of falls at younger age
significance: 2x inc risk of injury vs gen pop
what mental health issues are common in IDD
anxiety and depression
- and many others
what is the challenges (2) with mental health issues in iDD
- lack of provider confidence in dx
- dec provider knowledge of presentation of mental illness in IDD
when is it important to consider mental health issue influences in our practice of treating someone w IDD
if seeing changes in behavior we don’t understand
- screen mental health
what are 2 impacts of chronic fatigue in IDD
- affects level of exertion
- diminished ms mass and force production associated w chronic condition
what is a possible cause of chronic fatigue in IDD
developmental issues growing up that were exacerbated leading to chronic fatuge
what are 2 impacts of poor sleep in IDD
pain
gastroesophageal refulx
life expectancy in IDD and what is suspected reasoning
20yrs less than gen pop
- in US avg 75-80yr -> 55-60 in this pop
d/t chronic issues, access to healthcare
describe the utilization of healthcare services in IDD
individuals w IDD don’t receive health services that diverse range of health conditions require
what are 3 barriers to health care services in IDD
- nature of health care system
- common characteristics among individuals w ID/IDD
- characteristics and skills of providers
what are 5 barriers d/t the nature of the health care system and IDD
- inadequate medical insurance coverage
- lack of accessible treatment facilities
- poor coordination w/i healthcare system and b/w providers
- poor continuity of care for individuals w IDD - rarely see same provider
- poor coverage for and limitations in use of speciality services
what is often a healthcare provider when people w IDD become adults
hard fro pts to transition from pedi to adult providers since there are less adult providers
describe the specifics that lead to poor coverage and limitations in specialty services for IDD (2)
- inadequate # of specialized providers (ie derm, gastroentero, immunol)
- insufficient reimbursement and inapprop limitations by payers for certain services
how is there a lack of accessibility to treatment in IDD
physical lack of accessibility to facility
- lack of transportation
also lack of providers willing to work w this pop
what are 5 ways that the characteristics of persons w IDD are barriers to health care
- limited communication skills -> impedes clinician-pt interactions
- physical and behavioral impairments
- difficulty adhering to treatment regimens
- reliance on caregivers to seek care in system w high caregiver turnover
- inadequate family resources
what are 3 provider characteristics that are barriers to healthcare to IDD
- lack of primary care provider training
- poor documentation of services
- provider attitudes
how is there a lack of primary care provider training in healthcare of IDD (2)
- in interacting w individuals w IDD
- management of common problems in individuals w IDD
how is there poor documentation of healthcare services provided to IDD
lack of medical records that accurately document case hx
what negative provider attitudes are present w regard to IDD (4)
- persistent lack of knowledge
- disbelief in pts w IDD will benefit from treatment
- doubt pts w IDD willing to take care of selves
- more difficult to work w and less compliant
what are 4 major roles of PTs in treating IDD
- design & implement safe exercise exercise programs
- adapt equipment & positioning
- identify community resources
- expand service delivery
what are 3 goals of PT exercise programs in IDD
fitness
vitality
pain management
what are 4 targets of PT exercise programs in IDD
wt management
bone health
strength/ms mass
cardiovascular fitness
who should PT consult w when prescribing adaptive equipment for IDD (2)
community organizations
PCPs
what are 2 goals of adaptive equipment and positioning in IDD
- support full participation
- enhance comfort for sleeping in home
what community resources should PT seek out in advocating for IDD (3)
- community gyms w trainers/equipment accessible
- consultation w vocational/employer services
- advocate for accessible rec and outdoor opportunities
what are 4 roles of PT in service delivery to IDD
- facilitate transition of pedi to adult service provision
- training in working w people w IDD
- collaborate w other providers
- access to care
what other providers should PT collaborate w in service delivery to IDD (3)
pedi
adult
neuro
what are 5 attributes PT should consider when thinking ab IDD access to care
attitudes at clinic
funding
physical accessibility
transportation
community programming
what are 5 screening fields of FUNfitness for IDD
flexibility
strength
balance
aerobic
education
what is the average age of pts w IDD screened in FUNfitness
22.6yo
what is the greatest need of people w IDD screened by FUNfitness
education
what do coaches of FUNfitness for IDD need
guidance ab fitness
what has FUNfitness found ab incidence of health issues in screening IDD
almost all athletes have a limitation in an area of screening
- 70% have limitations in 3+ areas of 5
Healthy Athletes found that 50% of those screened w IDD found limitations in what 3 fields across all ages
flexibility
strength
balance
what are 4 things which success as an adult w IDD is linked to
- excellent med care
- participation in regular fitness activities
- support systems
- “accept me for who i am” attitude
what are 3 ways PT should address mental health in IDD
- screen for mental health conditions
- use relaxation techniques
- refer for CBT
what are 5 modes of communication in IDD
verbal
ASL
written
assistive tech
via healthcare proxy
what are 4 strategies to utilize when communicating w someone w IDD
- speak at slightly slower pace
- be redundant but not repetitive
- allow extra time for pt response
- confirm comprehension - teachback method
what are 3 ways to modify PT treatments for IDD
- employ communication strategies
- consider likely presence of co-morbidities and multisystem involvement
- break down task into few easy steps
