Improving our understanding of physical health issues ... · PDF fileImproving our...
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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
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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
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► Prof. Heleen Evenhuis, head of staff
Healthy Ageing and Intellectual Disability study (HA-ID)
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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
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Geographical locations of the three care providers
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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
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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
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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
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Sample characteristics – Age
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Sample characteristics – Level of ID
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Sample characteristics - Mobility
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Physical activity and (instrumental) activities of daily living
► Principal HA-ID investigator: Thessa Hilgenkamp ([email protected])
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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.
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Why is physical activity so important?
► It predicts mortality
► It reduces the risk of illness
► It improves the health of the elderly Physical
Psychological
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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
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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
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Physical activity: HA-ID results
► 10000 steps/day norm: not met in 83%
► 7500 steps/day norm: not met in 64%
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(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
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ADL and IADL: relevance
► ADL: self-care
► IADL: independent living
► Determines need for (intensive) care
► Declines with age
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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
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% 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
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% living independently (IADL)
IADL % independentLiving completely independently 2Telephone use 26Groceries 28Preparing food 13Household tasks 10Laundry 11Transportation 13Handling medication 14Handling money 21
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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+)
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Cardiovascular risk and overweight
► Principal HA-ID investigator: Channa de Winter ([email protected])
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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.
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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)
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Cardiovascular risk prevalence
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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
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Overweight and obesity: HA-ID variable definitions
► BMI (>25 overweight; >30 obese)
► Waist circumference
► Waist-to-hip ratio
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Obesity prevalence
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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
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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.
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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
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Osteoporosis: HA-ID
► Measured with quantitative ultrasound (QUS, Lunar Achilles Insight)
► 771 people were available for QUS
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Osteoporosis: prevalence
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Osteoporosis: Related factors
Correlate Odds ratioWomen 1.4Walking with an aid 2.0Wheelchair dependence 3.2Anti epileptics 1.3Level of ID 1.6
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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
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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
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Thank you
AbronaAmarant
Ipse de BruggenUniversity of Groningen ZonMw
(Sponsor)
Michael Echteld ([email protected])