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Improving our understanding of physical health issues among people with intellectual disabilities as they ageFindings from a multi-centre epidemiological study in The NetherlandsMichael A. Echteld
The assignment
► Comparing IDS-TILDA outcomes with outcomes from the Healthy Ageing and Intellectual Disability study (Netherlands)
► Selection of IDS-TILDA results Physical activity
Activities if daily living
Cardiovascular risk factors
Overweight and obesity
Osteoporosis
► Prof. Heleen Evenhuis, head of staff
Healthy Ageing and Intellectual Disability study (HA-ID)
HA-ID overview
► Multi-centre epidemiological study on health in people ≥50 years
► Data collection in three large care centres
► Near-representative for all people with ID receiving formalised care in the Netherlands
► All data were / are collected by professionals appointed at the university and the care centres
Geographical locations of the three care providers
Population of the three care providers
► 8550 clients = 10% of the Dutch client population
► All levels of ID
► Various care settings Central residential
Community based homes
Day activity centres
Supported living homes
Research themes of HA-ID
► Epidemiological studies Physical activity and physical fitness
Nutrition and nutritional state
Depression, anxiety and cognition
Sleep and sleep problems
Frailty
Heart disease and its risk factors
► Intervention study Physical activity
Inclusion
► Data collection period Epidemiological studies: 2009-2010
Intervention study: 2010-2011
► Inclusion criterion: ≥50y of age
► 2150 clients ≥50y were available and invited
► 1050 clients provided informed consent
Sample characteristics – Age
Sample characteristics – Level of ID
Sample characteristics - Mobility
Physical activity and (instrumental) activities of daily living
► Principal HA-ID investigator: Thessa Hilgenkamp ([email protected])
Physical activity: IDS-TILDA
► Overall, Irish adults with an ID reported that they hardly ever engaged in vigorous physical activity
► Those who did engage tended to be men in the younger age groups
► 80% did engage in some form of physical activity, at least once a week.
Why is physical activity so important?
► It predicts mortality
► It reduces the risk of illness
► It improves the health of the elderly Physical
Psychological
How much physical activity is necessary?
► 30 minutes of moderately intensive activity
► Norm: 10000 steps/day
► Significant health effects at 7500 steps/day
Steps/day Intensity < 5000 Sedentary5000-7499 Slightly active7500-9999 Somewhat active10.000-12.500 Active>12.500 Highly active
Physical activity: HA-ID methods
► Measuring physical activity Counting steps using a pedometer
► Selection Comfortable walking speed ≥ 3.2 km/h
Being able to complete a fitness test
257 clients (25%) were selected
Physical activity: HA-ID results
► 10000 steps/day norm: not met in 83%
► 7500 steps/day norm: not met in 64%
(Instrumental) activities of daily living: IDS-TILDA
► Difficulty with activities of daily living (ADLs) and instrumental activities of daily living (IADLs) was most notable in older age
ADL and IADL: relevance
► ADL: self-care
► IADL: independent living
► Determines need for (intensive) care
► Declines with age
ADL and IADL: HA-ID methods
► ADL measured with the Barthel index
► IADL measured with the Lawton IADL Scale
► ADL and IADL data were available of 989 people
% independent with respect to self-care (ADL)
ADL % independentFully independent in self care 15Bowel continence 60Bladder continence 53Grooming 31Toilet use 56Food 60Bed – chair transfers 75Walking 76Dressing 55Walking stairs 52Showering 36
% living independently (IADL)
IADL % independentLiving completely independently 2Telephone use 26Groceries 28Preparing food 13Household tasks 10Laundry 11Transportation 13Handling medication 14Handling money 21
Factors related to ADL and IADL
► ADLMobility ++
Level of ID +
► IADL Level of ID ++
Mobility +
► ADL and to a lesser extent IADL decline with age (70+)
Cardiovascular risk and overweight
► Principal HA-ID investigator: Channa de Winter ([email protected])
Cardiovascular risk: IDS-TILDA
► Cardiovascular risk factors were high among people with intellectual disability (ID), with a marked gender difference; women were at greater risk. Prevalence increased with age.
Cardiovascular risk: HA-ID variable definitions
► Hypertension
► Diabetes
► Hypercholesterolemia
► Metabolic syndrome►3 out of 5: raised BP, raised triglycerides, lowered HDL
cholesterol, raised glucose, central obesity (Circ 2009 120:1640-5)
Cardiovascular risk prevalence
Overweight and obesity: IDS-TILDA
► Sixty one percent of Irish adults with ID are overweight or obese, based on self-reported height and weight data
Overweight and obesity: HA-ID variable definitions
► BMI (>25 overweight; >30 obese)
► Waist circumference
► Waist-to-hip ratio
Obesity prevalence
Related factors of obesity measured using the waist-to-hip ratio
Correlate Odds ratioWomen 5.8Older age 1.4Down syndrome 1.8Being able to eat independently 1.6Preparing meals independently 1.6
Osteoporosis: IDS-TILDA
► Overall prevalence of reported osteoporosis is slightly lower among people with ID than that reported by TILDA (2011) for the general population, but marked gender and age differences were detected.
Osteoporosis
► A condition of decreased bone mineral density (BMD)
► Decreased BMD leads to greater risk of fractures
► Risk factors for osteoporosis: Female gender
Age
Lack of physical activity
Vitamin D deficiency
Low calcium intake
Corticosteroid intake
Osteoporosis: HA-ID
► Measured with quantitative ultrasound (QUS, Lunar Achilles Insight)
► 771 people were available for QUS
Osteoporosis: prevalence
Osteoporosis: Related factors
Correlate Odds ratioWomen 1.4Walking with an aid 2.0Wheelchair dependence 3.2Anti epileptics 1.3Level of ID 1.6
Conclusions
► The results regarding physical activity converge
► Influence of age on (I)ADL was less pronounced in the HA-ID study than in IDS-TILDA
► The results regarding cardiovascular risk factors converge
► In HA-ID, gender, but not age was a correlate of osteoporosis, as compared to IDS-TILDA
Future directions
► Improving physical activity is likely to have major physical health benefits (overweight, ADL, osteoporosis)
► Because many health-related problems are interrelated, an integrated, multifaceted approach to health promotion is needed
► Insight into overall markers for health and ageing such as frailty need to be explored
► European collaboration will be beneficial
Thank you
AbronaAmarant
Ipse de BruggenUniversity of Groningen ZonMw
(Sponsor)
Michael Echteld ([email protected])
