Primary care of the adult with intellectual and developmental disabilities
- Robert Baldor, MD
Robert Baldor, MD
- Professor of Family Medicine and Community Health
- University of Massachusetts Medical School
Developmental disabilities refer to a number of different conditions with onset in childhood; intellectual disability (ID) is a nonspecific term that refers to a mental capacity below normal, due to any condition that impairs development of the brain before birth, during birth, or in the childhood years. ID (also referred to as cognitive impairment or cognitive adaptive disability) is replacing the older terminology "mental retardation."
Intellectual disability affects 0.6 to 2.5 percent of people in the United Kingdom and the United States [1,2]. People with intellectual disability are living longer than in the past and most are living in the community rather than in institutional settings. Patients with Down's syndrome live, on average, twice as long as they did 25 years ago . Thus, the adult primary care clinician will be providing healthcare for increasing numbers of patients with intellectual disability and cognitive impairment.
Unfortunately, disparity exists in health services provided to those with intellectual disability, when compared to the general population [1,4]. Patients with ID are less likely to receive adequate medical care than the general population, despite their increased burden of chronic health problems [4,5]. Patients with ID have shortened life expectancy (ranging from 13 to 20 years shorter), increased numbers of medical problems, and decreased rates of recommended preventive health interventions. These issues can be attributed to multiple factors [2,5]:
●Genetic factors that result in both ID and a greater burden of somatic health problems
●Communication difficulties involving the patient, caregivers, and health providers
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- DIAGNOSIS AND CLASSIFICATION
- Genetic disorders
- APPROACH TO THE PATIENT
- Routine healthcare
- Scheduling visits
- Issues of special concern
- - Legal issues
- - Sexuality
- - Victims of violence
- COMMON PROBLEMS
- Mental illness
- Seizure disorder
- Cerebral palsy
- Behavioral disorders
- Dementia and cognitive decline
- Oral hygiene
- SYNDROME SPECIFIC ISSUES
- Down syndrome
- Fragile X syndrome
- Fetal alcohol syndrome
- Prader-Willi syndrome
- SUMMARY AND RECOMMENDATIONS