Presented by:

Rita J. Murphy RN,BSN,CDDN

Cathy N. Shaffer RN

Jody Thomas RN

AgingIntellectual and Developmental

Disabilities

Why are People Living Longer ?

Life expectancy is unpredictableRemarkable advances over the past 50 years

Public Health Sanitation Immunizations Antibiotics Nutrition Social policy Environment

Historic group of individuals

Define: Developmental Disability

A condition that occurs prior to , at birth or during childhood which affects normal growth and development Depends on the functional capabilities of the individual and

affects on physical and /or cognitive abilities Condition may interfere with:

Mobility Speech ADL’s Learning Making life decisions Living independently

Life Expectancy

Leading cause of increased life expectancy: Moving out of institutions Receive better medical care

Life expectancy is now closely approaching that of the general population

May have related conditions that affect life expectancy Severe Impairments include:

Cerebral Palsy Down Syndrome Epilepsy

Dr. William Thomas & Normal Aging

“Aging is not a chaotic mechanical breakdown rather…Aging can be thought of as a symphonic

physiological developmental process that extends across the decades”

The Process

Older individuals with ID may exhibit relatively higher rates of: Mobility Issues Fractures Osteoporosis Visual Hearing Mental health Poly-pharmacy Depression

Older individuals with IDD may not have built reserves to support their aging and wellness- body, mind and spirit

Older individuals with IDD/DD may have lead a sedentary life style and have not been encouraged to exercise

Maximum Vitality

Reach maximum vitality at an earlier ageThe body responds to stressorsMaximum vitality in the general population:

Age 30

Common Factors –Aging and IDD/DD

The aging process /factors of aging, can further alter function that has already been affected by a developmental disability.

Down Syndrome, Epilepsy and CP Layering of Issues due to IDD/DD:

Hearing Vision Mobility Self-care skills

Communication and understanding Further complicates the aging process and an accurate diagnosis

Difficult to differentiate disease vs. aging process for the severely impaired

May have fragmented care with little medical and family history

Lifespan

According to studies, causes of death are similar to those of the general population

Causes of death include: Cardiovascular disease Respiratory disease Cancer

(Janicki, Dalton, Henderson,& Davidson,1999)

Identifying Changes

Observe facial expressions Alert Sleepy Confused Anxious Painful

Observe response Usual response or off?

Individuals may be poor reporters

It is important to know: How they have

presented throughout their life

Their storySupport and honor the

Direct Support Professionals who know our individuals

The Integumentary System (SKIN)

Our bodies first line of defense and the system that you notice first with age

Individuals with IDD/DD have a higher risk for: Immobility

Loss of thickness Less insulation Skin tears and breakdown

Inability to report pain and discomfort Possible bowel or bladder issues Diminished or elevated sense of touch Difficulty healing No access to water on their own or complain of thirst Poor hygiene skills

HEARING, VISION AND ORAL

GI /GU

VACCINES

ASPIRATION PNEUMONIA

SENSORY PROCESSING

FALLS

Specific Issues

Hearing, Vision and Oral

Individuals may experience: Impaired vision due to a neurological deficit Unable to voice changes in vision Improper use bifocals and hearing aides Higher incidence of hearing issues (wax build up) Misplace or refuse to wear assistive devices Unable to open their mouth Oral changes due to medications

Poor oral hygiene Lack of adequate dental care

Ill fitting dentures Problems with choking, aspiration and food consistency

Small group of Dentists who understand and can work these individuals

GI/GU

Individuals with IDD/DD have higher risk for: Bowel obstruction GERD Slower stomach emptying

Poor hygienePossible gluten intolerance

Wheat sensitivity Full Celiac disease

Problems with incontinence

Vaccines

Who should get a pneumococcal vaccine, flu shot and possibly a shingles vaccine? Individuals age 65 or older Those prone to respiratory problems, including:

Myotonic Dystrophy Down Syndrome

Those who are medically frail Those with severe IDD/DD

Individuals with Down Syndrome: Carefully watch for signs and symptoms of an upper respiratory

infection, it may lead to pneumonia Antibiotics should be prescribed early on to prevent full blown

pneumonia. Pneumonia is the leading cause of death in this population.

Aspiration Pneumonia

Causes: Inhalation or the breathing in of fluids, vomit or foods Eat too fast, hoard and may fear the eating process Poor dentition - missing loose or decayed teeth

Increase the incidence of aspiration and poor fitting dentures The aging, both the general population and ID/DD population, are

prone to aspiration if they have difficulty chewing and swallowing Individuals with Down Syndrome

Tongue thrust Mouth breathers Dry mouth

Individuals with Cerebral Palsy & Myotonic Dystrophy Increased incidence of aspiration

Sensory Processing

The Senses Hearing Taste Vision Smell Touch Proprio-ception Vestibular

All 7 senses are needed and work together to help make sense of the environment

Senses determine responses to the environment

Information processed by senses can be changed by the process of aging

Vision and hearing affected earlier for IDD/DD

Preferred Senses: Everyone has one Possible loss due to aging

Design the environment to enhance our senses as we age

In order to minimize loss of our senses as we age: Continue to program pathways to the

brain

(Kathleen Bishop, PH.D.)

Falls

Individuals with IDD/DD… Are living longer May have a dual diagnosis (IDD,MH) Have underlying issues with mobility Increase risk of developing Osteoporosis, due to

medication Led sedentary lifestyles

This decreases bone density, increases prevalence of osteoporosis

Falls in the General Population

Environmental Slippery falls Poor lighting Throw rugs Cluttered walking

paths Uneven

sidewalks/broken curbs

Poor fitting shoes

Physical Change in balance control Vision and hearing changes Muscle weakness Osteoporosis /osteoarthritis Medication side effects Taking 3 or more

medications Diabetes (decreased

sensation in feet) Mental decline/confusion Seizures

AGING AND DOWN SYNDROME

WHAT CAN WE EXPECT?

DOWN SYNDROME & ALZHEIMER’S DEMENTIA

Down Syndrome

Aging and Down Syndrome

Disorder of chromosome 21Chromosomes are usually found in pairs

Trisomy of chromosome 21 Accelerated aging gene found on chromosome 21Aging and Down Syndrome not completely understood

(ndss 2013)

Appear to slow down in their 40s or 50s (ndss 2013)

Have an increased risk for age related visual and hearing disorders, depression, seizure and Alzheimer’s disease, skin, endocrine and upper respiratory infections /pneumonia, celiac disease and sleep apnea

Individuals with Down Syndrome Danny at the Ball

What Can We Expect?

Lifespan: Less than general

population and/or DD population

Living into their 50’s, 60’s and 70’s

Down Syndrome & Alzheimer’s Dementia

Risk of developing Alzheimer’s increases with age At age 50:

30% of individuals At age 60

50% of individuals Not all individuals will develop Alzheimer’s At age 30 and 40

Changes in brain matter may occur Will not develop clinical symptoms

Diagnosis: It is over diagnosed Cannot determine in one MD visit NTG is an early screening tool

Maximum environmental supports

AGING AND CEREBRAL PALSY

DR. MICHAEL HENDERSON

AS PEOPLE WITH CEREBRAL PALSY AGE. .

Cerebral Palsy

Aging and Cerebral Palsy

One time injury to the immature central nervous system Condition not a disease May or may not have an intellectual or developmental

disabilityAffects the central control of muscle function

Movement Balance

Life long neurologically induced motor impairmentAging is similar to general population

Timing of changes may vary

Dr. Michael

Henderson

Simple voluntary action or task may require increased effort

Difficulty with muscle movements• Poor coordination• Rapid muscle

movements• Weakness in their

muscles• Involuntary or

writhing muscle movements.

“Cerebral palsy (CP) is one of the most common developmental disabilities. About 65% of people with cerebral palsy have an Intellectual or Developmental Disability.

The majority of cases of cerebral palsy are caused by abnormalities of the developing

brain that took place prior to birth. Cerebral palsy refers to a variety of conditions that are characterized by

abnormal motor actions.” (movements of the muscles and corresponding limbs).

As People with Cerebral Palsy Age..

Individuals may experience Increased pain in muscles and joints

Arthritis Bursitis Tendonitis Pain due to fractures or sprains and osteoporosis

Possibility to opt out of walking Problems with skin integrity Depression due to losses in function Concerns with eating, swallowing, choking issues and GERD Increased body weight, obesity and deconditioning Constipation and bladder issues Spasms may cause pain and decrease function/mobility

Down Syndrome & Cerebral Palsy

Observed acute or chronic loss of function in an individual with CP or Down Syndrome(or general population for that matter): A change in the way the person walks Inability to use an arm Decrease in hand writing skills Feelings that hands do not function as they did before

Must be reported to a medical professional A prompt and thorough evaluation by an MD is essential to the

health and wellness of the individual.

CATHY WILL SHARE STORIES REGARDING THE IDD/DD POPULATION

FROM A MENTAL HEALTH STANDPOINT.

ENJOY PHOTOGRAPHS FROM ONTARIO ARC’S IDD/DD POPULATION.

Mental Health

Contact Information

Rita MurphyLearning & Development Specialist - RN rmurphy@arcmonroe.org585-271-0660

Cathy ShafferCoordinator of Clinical Services - RN cshaffer@lwarc.org585-658-2828

Jody ThomasManager of Aging Services - RNjthomas@ontarioarc.org 585-919-2161