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Ageing

4. Health

4.2. Early signs of declining health in older adults with ID

Persons with ID who survive and live into older age the combination of life-long disorders, their associated medications use and ‘normal’ ageing processes are at a greater risk for ill-health and an earlier burden of disease. 

Low-income that limits access to healthy food choices, high energy (sugar) and low vegetable intake, some antipsychotic medications, lack of physical activity and a lack of health education all increase the risk of developing a broad spectrum of cardiovascular and cerebrovascular, pulmonary, metabolic and neoplastic diseases, osteoarthritis, need for anesthetics and surgery (1). 

Man with walking sticksPhoto: Lars Aage Hynne

Lack of physical activity combined with dental ill health and inappropriate nutrition resulting in overweight and obesity are the most important preventable, modifiable risk factors. Efforts made at a younger age affect older years and enable people to develop healthy lifestyle habits that will ensure they continue to mature and age with a sense of well-being. Survival of people who have lost their mobility are poorer in later life than in the general population (1).

Early signs of declining health in older adults with ID more common than other health issues are (1):

  • Cancer (see more information in chapter 4.7)
  • Dementia; extremely early in Rett Syndrome and Angelman and frequent in Down’s Syndrome
  • Hearing impairment, caused by chronic middle ear infections and ear wax blocking the canal, and a moderate prevalence for sensorineural and mixed hearing loss
  • Hepatitis B, Tuberculosis and Helicobacter Pylori (HP) infections of people who had been formerly institutionalised
  • Musculoskeletal pain
  • Oral and dental health; i.e. gingivitis is earlier, more rapid and extensive with Down’s syndrome
  • Osteoporosis and associated fractures
  • Overweight and obesity
  • Side effects of drugs
  • Unprocessed trauma of abuse and violence
  • Vision problems i.e. refractive errors, strabismus, cataracts, and kerataconus, hyperopia, myopia, and astigmatism

Some say that all persons with severe and profound ID and all older adults with Down’s syndrome should be considered as visually impaired until proven otherwise. In older adults with ID in general the vision impairments are more severe because of pre-existing childhood onset visual pathology and other co-existing sensory and physical impairments (2).

Older adults without a lifelong vision impairment may not be well prepared to manage their impairment in older age. Absence of education, rehabilitative efforts or changes in the physical environment to cope well with their vision problem, may get more consequences than necessary. Family and staff, are often not sensitive, experienced or informed enough to deal effectively with significant regression of vision and hearing function (1).

Older women with less severe disabilities and those with certain syndromes i.e. Down syndrome and Prader-Willi syndrome are more likely to be obese, compared to their counterparts. It may be difficult to build a healthy lifestyle when there is stiffness and pain in the body because of ageing. Therefore, pain assessment is important in older age.

Cardiovascular diseases are less confirmed and people with ID have relatively low rates of hypertension and hyperlipidemia. At the same time, cardiovascular disease is reported to be the primary cause of death for people with ID in most western countries. 

Early signs of declining health, especially in older adults with Down’s syndrome are:

Early signs of declining health, sometimes already from 20-30 years of age may occur in adults who are non-ambulatory i.e. with cerebral palsy, permanently reliant on using wheelchairs for mobility and persons with severe and profound ID (1, 3):

  • A marked decline over 60 in deterioration of muscular function; exacerbate already low Bone Mineral Density scores with potential consequences for early onset of osteoporosis and brittle bones
  • Cardiovascular disease risk factors
  • Depression
  • Increasing cognitive difficulties
  • Overweight and obesity, BMI more than 27
  • Problems with swallowing - feeding and posture
  • Respiratory disease are thought to be mainly due to pneumonia and aspiration, normally associated with Gastroesophageal reflux disease (GERD)
  • Risk factor for constipation (obs specific drugs)
  • Type 2 diabetes

Studies shows that persons with severe and profound ID have lower rates of hyperlipidemia, overweight and obesity, type 2 diabetes and there were lower rates of hypertension compared to persons with mild and moderate ID. We also assume that smoking is less common in persons with severe and profound ID.

A perception of good physical health is associated with good mental health. Subjective well-being and personality influences the person’s perception of mental and physical health. 

People with a severe degree of ID have a three to four times’ higher probability of experiencing mental problems than normal population. At the same time, it is assumed that persons with a mild degree of ID have one to two times’ higher probability than people with a moderate degree of ID. There is, however, a divergence between studies of mental health (4, 5).

Connections between life events and mental problems are well documented, so is the correlation between depression and unpropitious life conditions (6). People with a mild degree of ID with essential features for being integrated may feel they have to hide their disability and their past e.g. the feeling of shame of growing up in an institution (7). Such situations can lead to an unhealthy and stressed state, especially if this is their daily issue. Growing up in an institution also involves a high risk of stress, which may lead to psychological difficulties (4).


ACTIVITIES:

  • Reflect on the diagnosis your child/sibling/client have and connect this to the risk of early ageing; what do you think the highest risk of declining health in this case is?
  • The most important thing is an assessment of health that can be done by persons close to the ageing person. How can you observe early signs of health issues in your child/sibling/client and how can you involve them in this assessment? 
  • Discuss with your child/sibling/client about the importance of taking care of own health and pointing out places in the body that hurts.
  • Ask your child, sibling or client about their daily life, and if there are situations or people that stressing them. Do they feel happy, sad or angry most of the time? What makes them feel happy, sad or angry?
  • Ask your child/sibling/client about their cooping strategies to feel satisfaction in their daily life.

Photo: Jørn Grønlund