Similarities and differences in health conditions

In an earlier video, we established that we now have a growing population of older adults with an intellectual disability, in better health, who are living longer. Despite this increased life expectancy, significant health disparities remain. And the age of death is considerably lower than the general population. Today, we are going to explore the health conditions experienced by people with an intellectual disability. We will examine the differences and similarities when compared to the general population. The World Health Organisation has emphasised that, because of the compelling needs associated with ageing, and intellectual disability, special attention needs to be given to this segment of the world’s growing older population.

People with an intellectual disability are subject to the same illnesses as all other persons without disability. However, because of lifelong disability, people with an intellectual disability experience health differently. So what are the prominent health conditions experienced by people with an intellectual disability? Some of the greatest health threats can be attributed to lifestyle changes in the last century. Obesity is at unconventional proportions in the Western world, contributing to heart disease, diabetes, hypertension, stroke, and cancer. Over 17.7 million people die each year as a result of cardiovascular disease, which is an estimate 31% of all deaths worldwide.

Over 80% of these deaths are from heart attacks or stroke and more than 75% of the deaths, from cardiovascular disease, occur in low and middle income countries. For people with intellectual disability, the picture of prevailing health conditions are different. Research by McCarron and colleagues, in 2013, identified that the patterns and pairs of diseases, common to people with intellectual disability, differ to those of the general population. Cardiovascular diseases, as noted earlier, are the most common conditions among the general population. This comprises of heart disease, hypertension, stroke, and diabetes. By comparison, eye disease, mental health conditions, neurological disease, joint disease, and gastrointestinal conditions are the most common occurring conditions among older people with intellectual disability.

Some of the prevalence differences identified include, for example, epilepsy. Where over 38% of older adults with an intellectual disability present with epilepsy, whereas just below 1% of the general older population have epilepsy. For those with Down syndrome, the onset and prevalence of Alzheimer’s dementia, with co-occurring epilepsy, is much greater than the general population. The prevalence of hypertension and heart attacks is also much lower for people with intellectual disability. However, that is not to say that people with an intellectual disability do not suffer with cardiovascular disease. Indeed they do, however, the rates appear to be lower than the general population. In Ireland, we have been researching the health of older adults with intellectual disability.

The study, known as the IDS-TILDA study, replicates the general population study, TILDA, and sits within the global family of longitudinal ageing studies. IDS-TILDA is exploring the health of people with intellectual disability and is comparing that to TILDA. What we have identified, and can be seen here in this graph, is that people with intellectual disability have higher prevalence of chronic conditions than the general population. The presence of multiple morbidity is also notable among older people with intellectual disability. Multiple morbidity is the co-occurrence of two or more health conditions. People with intellectual disability have been identified as having almost 72% multiple morbidity, compared to 58.6% in the general population.

But what is striking is that the levels of multiple morbidity, among the younger cohort of people with intellectual disability, age 40 to 49, is the equivalent to the levels seen in older age cohort, those over 75 years in the general population. So in all, you can begin to see that those with an intellectual disability do have different challenges. And these health challenges are different to older adults in the general population. These challenges can compromise independent living and impact on overall health and well-being. For health care providers, this presents unique challenges which we will be exploring in this course. One of these challenges is engaging people with intellectual disability, and health promotion, and health screening.

As deinstitutionalisation becomes the norm, and people live in community settings, as well as with family, delivery of health services is changing. There is a changing landscape of care. No longer will people be in receipt of their health care in separate specialised centres. Instead, people with an intellectual disability, will receive their health care in primary health care centres, from their local GP, at the local hospital, and from doctors and health care professionals, who may not be familiar with intellectual disability. This makes it imperative for healthcare professionals to engage, as you are doing, in further education, to enhance their skills to prove the lives of people with intellectual disability. However, there is a paucity of training opportunities, specifically for healthcare professionals.

An issue that ought to be a goal for health care providers to ensure quality of health care for all. So what do we need to do as we move towards the future? As governments and local groups plan to accommodate a growing number of older and ageing adults, it is important to include adults with intellectual disability in these health care arrangements.