Upload File

ageing with an intellectual disability. a higher burden of illness undetected illness untreated...

  • Home
  • Documents
  • Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General
42
Ageing with an Intellectu al Disability

Upload: gabriel-cook

Post on 23-Dec-2015

214 views

Category:

Documents


0 download

Report

Tags:

TRANSCRIPT

Page 1: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

Ageing with an

Intellectual Disability

Page 2: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

A Higher Burden of Illness

• Undetected illness

• Untreated illness

• Delayed treatment

• Less likely screening

• General risks related to ageing

Page 3: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

What Can Group Home Staff do?

• Anticipate and prevent problems that are preventable

• Identify indicators of illness

• Advocate for appropriate screening and treatment

• Prevent premature relocation

• Protect from harm and suffering

Page 4: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

Normal Ageing

Page 5: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

Predictable Changes

• Sensory• Hearing• Vision• Smell• Taste• Touch

• Skin

• Reserve, repair and replenish

• Response to illness

• Sleep patterns

Page 6: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

HO

W W

E S

EE

Page 7: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

Signs of Vision Problems

• Sheltering eyes from light

• Squinting, tilting head

• Being unusually cautious, falling, tripping

• Bumping into things

• Poor table manners

• Change in personal appearance

• Change in activity, withdrawing

• Confusion

• Difficulty recognizing people or objects

Page 8: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

People with Intellectual Disability• Increases with age like all older adults

• Higher vision conditions before old age

• People with Down Syndrome high risk

• Often goes undetected

• May require specialized vision screening

Page 9: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

Age Related Eye Conditions: Glaucoma

Treatable, preventable blindness

Irreversible vision loss, blindness

Silent and painless

Easily detected with exam

Treated with daily drops

Affects peripheral vision

Page 10: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

Diabetic Retinopathy

• Irreversible blindness• Bleeds from small vessels in

back of eye• Stains tissue and blocks vision

• Prevent diabetes

• Control blood sugar

• Mostly preventable with laser

Page 11: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

Macular Degeneration

• Not reversible or treatable

• Central vision affected

• Leads to blindness

• Optic nerve

• Smoking major risk

• Protection is important

Page 12: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

Role of Caregiver

• Preventable (diabetes)

• Detectable: prevent vision loss

• Often slow and subtle changes

• Advocate for screen and treatment

• Support follow through

• Behavior change is major indicator

Page 13: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

Hearing

Page 14: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

Sound Transmission

Page 15: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

Signs of Hearing Loss

• Difficulty hearing with background noise

• Misunderstanding

• Confusion

• Withdrawal

• Anger, irritation

• Uncooperative

Page 16: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

Intellectual Disability and Hearing Loss

• Much higher than general population

• Almost 100% in Down Syndrome

• Tremendous amount undetected

• May require specialized testing

• Poor follow through

• Challenges managing hearing aids

Page 17: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

Communicating with Hearing Loss

• Decrease background noise (fan, dishwasher, TV)

• Face-to-face, gain attention

• Indicate, gesture

• Change words, rephrase

• Change pitch (women’s voices)

• Most people cannot lip read

Page 18: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

Other Sensory Changes

• Smell• Decreased

olfactory cells• Medications• Spoiled food,

gas leaks, fire• Body odor

• Taste• Linked to smell• Taste buds 1/6• Decreased saliva• Medications• Consequences

• Eat more• Eat less• Eat spoiled

food• Eat odd foods• Salt and sugar

Page 19: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

Sleep and Ageing

• Less sleep needed and changed patterns

• Causes of sleep problems (Expectations)• Sleep during the day• Insufficient exercise • Medications• Pain, restless leg• Frequent urination (infection, diabetes)• Prostate enlargement• Cardiac problems

Page 20: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

Reserve, Repair, Replenish

• Reserve decreases with age• Decreased ability to maintain

body temperature• Diminished response to illness

• Fever• Pain• Heart rate

Page 21: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

Role of the Caregiver

• Identifying cues (behaviour change)

• Supplement to lost body cues and responses• Temperature• Food• Sleep• Environment • Protection (vision and hearing)

Page 22: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

Health Conditions Common in Older Adults

Page 23: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

General Comments

• Beware of sudden changes

• Be mindful of slow changes over time, baseline

• Don’t assume ‘its just getting older’

• Behavior change is common indicator of illness

• Ask the most familiar person or people

• The same symptom can be many things

• Sometimes there is more than one thing

Page 24: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

Common Conditions:

• Incontinence

• Falls

• Dehydration

• Untreated pain

• Obesity

• Delirium

Page 25: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

Incontinence

• Common, multiple causes, often reversible• Infection• Diabetes • Medications• Treatment for heart disease• Mobility• Fluids/caffeine• Overactive bladder/prostate• Don’t assume ageing

Page 26: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

Falls• Not normal

• Serious consequences

• General decline from inactivity

• Vision

• Medications (blood pressure drop)

• Pain

• Balance, tripping (feet, shoes, rugs)

Page 27: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

Dehydration

• Thirst reflex blunted

• Less water in muscles than younger (reserve)

• Mobility

• Fluid loss (diarrhea, vomiting, fever)

• Can be life threatening

Page 28: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

Unrelieved Pain

• Until recently believed to be pain insensitive

• High level of undetected and untreated

• Same population comparison (much lower)

• Many chronic conditions associated with pain

• GPs and specialists sensitive to verbal cues

• Patient report is gold standard

• Facial expression reliable indicator

Page 29: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

Delirium

• Commonly missed in all older adults

• Often mistaken for dementia

• Caused by• medications• illness, infection• dehydration• impaction

Page 30: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

Delirium

• Characteristics• Altered attention• Change in cognition• Sudden onset• Variable• Associated with illness

Page 31: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

What We Know

• People with ID are:• less likely to be diagnosed• less likely to be treated• suffer needlessly

• Untreated illnesses are often irreversible if left

• Caregivers are in a pivotal position to identify, advocate and protect and keep people home

Page 32: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

Older People with ID

• Same illnesses as all older adults

• Higher rates• Respiratory (leading

cause of death)• Diabetes (obesity,

inactivity)• Gastrointestinal

Increasing• Cancer (GI,

testicular)• Arthritis

• Less likely to treat• Heart disease

• Related to disability

• Obesity• Inactivity

Page 33: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

Gastrointestinal Conditions

• Much higher rate• Constipation up to 70% (meds, inactivity)• Reflux 50% (vs 7%)• Bowel and GI cancer• Hepatitis and H Pylori (institutional

exposure)• Choking• Highly associated with behavioral changes• Even with speech, unable to articulate

symptoms

Page 34: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

Why so Many Unidentified?

• 80% of diagnosis based on history

• Caregiver misinterpreting symptoms as age

• Misinterpreting symptoms as behavior

• Caregiver not noticing symptoms

• Change in caregiver

• Assumptions that screen will not be tolerated

• GP unfamiliar

Page 35: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

Working with GPs and Specialists

• Double appointment time

• Familiar person

• Decrease the wait time

• Accompany throughout

• Explain services at group home

Page 36: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

General Comments

• Beware of sudden changes

• Be aware of slow changes over time, baseline

• Don’t assume ‘its just getting older’

• Look for patterns

• Behavior change is common indicator of illness

• Ask the most familiar person

• The same symptom can be many things

Page 37: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

The Manual

Page 38: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

The Manual• Not a novel!

• Targeted use

• What’s normal

• Working with providers, families

• Advocating

• Common symptoms: providing the 80%

• Common conditions

• Resources

Page 39: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

Uses of the Manual

• General learning

• Support for advocating

• Creating expectations (Screening)

• Symptoms• Brief background/causes/consequences• Information needed• Team approach• Useful information for professionals

Page 40: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

The Trainer’s

Guide

Page 41: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

Using the Guide

• Response to resident• Symptoms• Conditions

• General learning

• Practice problem solving

• Tips for trainers

Page 42: Ageing with an Intellectual Disability. A Higher Burden of Illness Undetected illness Untreated illness Delayed treatment Less likely screening General

Group Activity

• Pick a trainer

• Review the case

• Guide your staff through the case

• Pick a resident you know

• Reconvene to discuss


Measuring the Duration of Untreated Psychosis Within First ...health services is the social stigma attached to a mental illness diagnosis (Compton & Esterberg, 2005; McGorry, 2002)

Mental illness takes many forms and affects countless Fast ...€¦ · The economic cost of untreated mental illness is more than 100 billion dollars each year in the United States

CONDITIONS MAY INDUCE PREVIOUSLY UNDETECTED …

Vision Screening Guidelinesclubrunner.blob.core.windows.net/00000060108/en-ca/...The Problem • Undetected and untreated eye disorders, such as amblyopia and strabismus, can result

Deciphering the enigma of undetected species, phylogenetic ...viceroy.eeb.uconn.edu › Colwell › RKCPublications › ChaoEtAl2017b.pdfDeciphering the enigma of undetected species,

o~Medical problems which are undetected 'o\\",.r.'~/1j ()i' untreated can lead to serious legal problems. " Failure to examine. for injuries i or treat for illness could easiiy be

ENVIRONMENTAL HEALTH RESEARCH SCAN · result in injury, illness, or death if not identified and managed properly.” Coastal waters, fresh water and other untreated recreational water

On the Angular Effect Of Undetected Clouds In Infrared Window … · 2018. 7. 17. · On the Angular Effect Of Undetected Clouds In Infrared Window Radiance Observations: Aircraft

Manual Supplement: Rosemount 2120 Level Switch...λDU Dangerous Detected λSD Safe Detected λSU Safe Undetected ... Fail Dangerous Undetected Failure that is dangerous and that is

Due to Stress and Poor Health, Officials in our Local Associations have suffered from life threatening consequence due to undetected signs of illness!

New MPLNET PBL Algorithm Reveals Previously Undetected ... · New MPLNET PBL Algorithm Reveals Previously Undetected Diurnal Variability Jasper Lewis, Code 612, NASA GSFC, Ellsworth

A LIFE-THREATENING DISEASE THAT CAN GO UNDETECTED

The Costs of Untreated Agitation

Bipolar Disorder - Ministry of Health€¦ · Bipolar disorder is a chronic relapsing illness, and, if left untreated, may pose signifi cant morbidity and suicide risks. Global estimates

Untreated Curtains

Untreated Inactive Pulmonary Tuberculosis

Explaining Racial Disparity in Bipolar Disorder Treatment: How Do … · 2018-10-10 · Bipolar disorder is a serious mental illness that goes untreated more often among blacks than

Dennis Holter Chief Advancement Officer - The Vision Council · 2014. 3. 28. · • 30% of school-age children have vision problems. • 11.5% of teenagers have undetected / untreated

in Untreated and Treated Wastewater

Ebola virus The Ebola virus causes an acute, serious illness which is often fatal if untreated. The most severely affected countries are: Guinea,

Diabetes - Leicester · 2 Another important type is gestational diabetes, which is a state of hyperglycaemia developing during pregnancy. If undetected and untreated, this condition

The impact of undetected cases on tracking epidemics: the ... · the unknown number of undetected cases, provided we make assumptions about their prob-ability distribution. The general

Quantum Imaging with Undetected Photons Gabriela Barreto Lemos

NSS S#=8 G18 ìí îì íëìó Attorneys... · We are a self-regulated profession. Recognizing the risks posed by untreated mental illness and substance abuse, it is our responsibility

Latrogenic dentistry due to undetected root resorption ... S (2015) Latrogenic dentistry due to undetected root resorption observed with CBCT after many attempted treatments: a case

White Paper Patient Centered Care Model Introducion ......illness –primarily as a result of physical health issues that are untreated or undertreated. UnitedHealthcare analyses of

BASIC TECHNIQUES FOR CARRYING OUT MISSIONS UNDETECTED …guidesmedia.ign.com/guides/772077/tenchu_z_techniques.pdf · basic techniques for carrying out missions undetected ... go

Guideline for Unexplained High Usage and Undetected Leak

2020 Clinical Roadmap...sleep enough; more than half of U.S. adults with mental illness go untreated. Financial worries cause anxiety and illness. Loneliness is also rising. So-called

New MPLNET PBL Algorithm Reveals Previously Undetected Diurnal Variability

Chapter 3. Failures and Failure Classification · I Critical failures Dangerous failures: detected and undetected Safe detected and safe undetected (spurious) failures I Non-critical

Flystrike - pdsa.org.uk · Flystrike is a very serious condition, caused by maggots feeding on skin and flesh. Left untreated, flystrike will quickly lead to severe illness and death

Overview of Cutoff Determinations and Risk Assessment ... · may lead to death or disability if undetected or left untreated. NBS includes analysis of biochemical or molecular markers

Determinants of Undetected, Unintentional Errors in Audited

Healthy London Partnership (HLP) Children · Non -identification of the illness by professionals (e.g. untreated post natal depression can lead to significant attachment problems);