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current as of July 8, 2010.Online article and related content http://jama.ama-assn.org/cgi/content/full/304/1/91. 2010;304(1):91-92 (doi:10.1001/jama.2010.906)
JAMA
Elizabeth A. Perkins; Julie A. Moran
Aging Adults With Intellectual Disabilities
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Genetic DisordersAging/ Geriatrics; Psychiatry; Psychiatry, Other; Rehabilitation Medicine; Genetics;
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COMMENTARY
Aging Adults With Intellectual Disabilities
Elizabeth A. Perkins, PhD, RNMHJulie A. Moran, DO
T
HE POPULATION OF OLDER ADULTS IN THE
U
NITED
States is projected to reach 70 million within thenext 20 years.
1
Increasing age is but one of manyfactors associated with disparities in health accessand outcomes, along with sex, nonwhite race, lower socio-economic status, geographic proximity to health profes-sionals,andhavingadisability.Moreover,withinthepopu-lation of those with disabilities, persons with intellectualdisabilities (ID) are further disadvantaged.
2
The potentialsynergisticeffectofincreasingagewithconcomitantmem-bership in a vulnerable population increases the risk of ex-periencing poor health.Owing to marked increases in life expectancy for indi-viduals with ID in recent decades, life expectancy of adultswith mild ID is rapidly approaching near parity with thegeneral population.
3
Persons with moderate or severe IDnow routinely live into their late 60s and late 50s, respec-tively.
3
Furthermore, older adults with Down syndromeare consistently living beyond their late 50s,
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with sporadicreports of individuals living to their 70s and even early80s. Consequently, the relatively rapid increase in a newpopulation of aging adults with complex medical and men-tal health problems has resulted in inadequate geriatrichealth care provision.AgingwithIDpresentssignificantchallenges,thebreadthand scope of which are only beginning to be understood.As older adults with ID achieve old age, they experiencephysicalagingchangesandage-relatedchronicdiseasescom-montothegeneralolderpopulation.However,properiden-tification and management of disease and physical disabil-ity related to aging remains an unmet need. Literaturesummaries continue to report consistently higher rates of morbidityandmortalityinadultswithID,aswellashighlyprevalent but frequently unrecognized or poorly managedhealth conditions such as vision and hearing impairments,obesity,epilepsy,skinconditions,dentalpathology,behav-ioral/mental health problems, gastrointestinal conditions,and need for long-term polypharmacy.
5,6
While the burden of increased comorbid conditionscuts across the population of adults with ID as a whole,the complexity of appropriate surveillance of medicalcare is further complicated by the diversity of syndrome-specific aging issues. The older adult with Down syn-drome, for example, experiences a phenomenon of accel-erated aging, characterized by increased rates of cataracts,hearing loss, hypothyroidism, osteoporosis, epilepsy,sleep apnea, and a genetically elevated risk of developingAlzheimer disease. Older adults with cerebral palsy (whooften have ID) are at greater risk of accelerated musculo-skeletal system aging, often leading to loss of mobility,osteoporosis, chronic fatigue, and chronic pain. Aging-related issues have also been identified in aging personswith Prader-Willi syndrome, Williams syndrome, andfragile X syndrome.
7
Research on the aging process of adults with autism spectrum disorders has largely beenoverlooked but may be stimulated by attention from theincreased prevalence of autism spectrum disorders andmovement toward a greater focus on life span outcomes.Although an increasing body of literature exists regardinghealth issues, robust epidemiological and population-level surveillance data are needed to identify the preva-lence of aging adults with ID, to characterize their healthstatus, and to determine their unique disease risks andtrajectories.There have been previous initiatives to improve the gen-eral health of persons with ID. The 2002 report from theUS Surgeon General’s Conference on Health Disparities andMental Retardation entitled “Closing the Gap: A NationalBlueprint to Improve the Health of Persons With MentalRetardation” set forth an ambitious agenda to improve thehealth of individuals with ID.
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The report highlighted dis-parities in health status, access to care, and health carequality and called attention to the lack of training of physi-cians and other health care professionals in the needs of individuals with ID across the life span. Nearly a decadelater, progress is slow, and efforts affecting the well-beingof older adults are even more marginal. Furthermore, thereis poor coverage of health promotion and preventive careprograms targeted specifically for older adults with lifelongdisabilities.
Author Affiliations:
Department of Child and Family Studies, University of SouthFlorida, Tampa (Dr Perkins); and Beth Israel Deaconess Medical Center Divisionof Gerontology, Boston, Massachusetts (Dr Moran).
Corresponding Author:
Elizabeth A. Perkins, PhD, RNMH, Florida Center for In-clusive Communities/UCEDD, Department of Child and Family Studies, Collegeof Behavioral and Community Sciences, University of South Florida, 13301 BruceB. Downs Blvd, MHC 2113A, Tampa, FL 33612 (eperkins@mail.usf.edu).
©2010 American Medical Association. All rights reserved.
(Reprinted) JAMA,
July 7, 2010—Vol 304, No. 1
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