Body mass index in adults with intellectual disability: distribution, associations and service implications: a population-based prevalence study

Background Previous studies of weight problems in adults with intellectual disability (ID) have generally been small or selective and given conflicting results. The objectives of our large‐scale study were to identify inequalities in weight problems between adults with ID and the general adult population, and to investigate factors associated with obesity and underweight within the ID population. Methods We undertook a population‐based prevalence study of 1119 adults with ID aged 20 and over on the Leicestershire Learning Disability Register who participated in a programme of universal health checks and home interviews with their carers. We performed a cross‐sectional analysis of the register data and compared the observed and expected prevalences of body mass index categories in the ID and general populations using indirect standardisation for age. We used logistic regression to evaluate the association of a range of probable demographic, physical, mental and skills attributes with obesity and underweight. Results In those aged 25 and over, the standardised morbidity ratio (SMR) for obesity was 0.80 (95% CI 0.64–1.00) in men and 1.48 (95% CI 1.23–1.77) in women. The SMR for underweight was 8.44 (95% CI 6.52–10.82) in men and 2.35 (95% CI 1.72–3.19) in women. Among those aged 20 and over, crude prevalences were 20.7% for obesity, 28.0% for overweight, 32.7% for normal weight and 18.6% for underweight. Obesity was associated with living independently/with family, ability to feed/drink unaided, being female, hypertension, Down syndrome and the absence of cerebral palsy. Underweight was associated with younger age, absence of Down syndrome and not taking medication. Conclusion Obesity in women and underweight in both men and women was more common in adults with ID than in the general population after controlling for differences in the age distributions between the two populations. The associated factors suggest opportunities for targeting high‐risk groups within the ID population for lifestyle and behaviour modification.     

Mortality in adults with moderate to profound intellectual disability: a population-based study

Background People with intellectual disability (ID) experience a variety of health inequalities compared with the general population including higher mortality rates. This is the first UK population‐based study to measure the extent of excess mortality in people with ID compared with the general population. Method Indirectly standardized all‐cause and disease mortality ratios (SMRs) and exact Poisson confidence intervals were calculated by age and sex for all adults, aged 20 years or over, with moderate to profound ID living in Leicestershire and Rutland, UK, between 1993 and 2005. The general population of Leicestershire and Rutland, which has a population of approximately 700 000 individuals in this age range, was used for comparison. To explore differences within the study population, overall SMRs were also calculated by presence of Down syndrome and last place of residence (city or county). Results Of 2436 adults identified, 409 (17%) died during 23 000 person‐years of follow‐up. Both all‐cause and disease‐specific mortality were around three times higher than the general population but varied considerably with age. The largest differences were observed in people in their twenties, where all‐cause mortality was almost nine times higher in men (SMR = 883; 95% CI = 560–1325) and more than 17 times higher in women (SMR = 1722; 95% CI = 964–2840). At a particular disadvantage were people with Down syndrome and women with ID living in the city. Conclusions The relatively high SMRs observed in young people and in women, particularly those living in inner city areas and with Down syndrome, deserve further investigation for possible explanations, including socio‐economic factors.     

Mental disorder in adults with intellectual disability. 1: Prevalence of functional psychiatric illness among a community-based population aged between 16 and 64 years

The reported prevalence of psychiatric illness among adults with intellectual disability (ID) varies widely between 10 and 39%; however, many methodological problems exist. The aims of the present study were to establish the prevalence of functional psychiatric illness among adults with ID who live in the community, in order to compare the overall rate and types of psychiatric illness between the population with ID and the general population without ID, and to establish the risk factors associated with psychiatric illness in adults with ID. The study was done in two stages. In the first part, a trained psychiatrist interviewed 101 randomly selected adults with ID and their carers using the Mini Psychiatric Assessment Schedule for adults with Developmental Disability (Mini PAS‐ADD) to screen for psychiatric caseness. Out of these 101 adults, 90 had sufficient communicative abilities that made the administration of Mini PAS‐ADD possible. A second trained psychiatrist interviewed 19 out of the 20 adults who were diagnosed as psychiatric cases according to the initial Mini PAS‐ADD interview. This psychiatrist interviewed patients and their carers in line with the full PAS‐ADD interview. The second psychiatrist was blind to the initial diagnoses made according to the Mini PAS‐ADD questionnaire. A final psychiatric diagnosis was made according to International Classification of Diseases – 10^th Revision (ICD‐10) criteria. Some 14.4% (95% confidence interval = 7.4–21.4%) of the cohort had a psychiatric diagnosis according to ICD‐10 criteria: 4.4% had schizophrenia, 2.2% depressive disorder, 2.2% generalized anxiety disorder, 4.4% phobic disorder and 1% delusional disorder. The overall rate of functional psychiatric illness (point prevalence) was similar to that found in the general population (16%). However, the rates of schizophrenic illness and phobic disorder were significantly higher in the study cohort compared with those in the general population (0.4% and 1.1%, respectively). Increasing age and the presence of physical disability were significantly associated with the occurrence of psychiatric illness. Out of the 11 remaining adults with severe ID, two (18%) had a diagnosis of a psychiatric illness (one mania and one anxiety disorder) according to the Diagnostic Assessment for the Severely Handicapped (DASH) questionnaire.     

Cause-specific mortality and death certificate reporting in adults with moderate to profound intellectual disability

Background The study of premature deaths in people with intellectual disability (ID) has become the focus of recent policy initiatives in England. This is the first UK population‐based study to explore cause‐specific mortality in adults with ID compared with the general population. Methods Cause‐specific standardised mortality ratios (SMRs) and exact 95% confidence intervals were calculated by age and sex for adults with moderate to profound ID living in the unitary authorities of Leicester, Leicestershire and Rutland, UK, between 1993 and 2006. Causes of death were also studied to determine how often ID and associated conditions, such as Down syndrome, were mentioned. Results A total of 503 (17% of population) adults with ID died during the 14‐year study period (30 144 person‐years). Relatively high cause‐specific mortality was seen for deaths caused by congenital abnormalities (SMR = 8560), diseases of the nervous system and sense organs (SMR = 1630), mental disorders (other than dementia) (SMR = 1141) and bronchopneumonia (SMR = 647). Excess deaths were also seen for diseases of the genitourinary system or digestive system, cerebrovascular disease, other respiratory infections, dementia (in men only), other circulatory system diseases (in women only) and accidental deaths (in women only). Two‐fifths (n = 204; 41%) of deaths recorded in adults with ID mentioned ID or an associated condition as a contributing cause of death. Conclusions Strategies to reduce inequalities in people with ID need to focus on decreasing mortality from potentially preventable causes, such as respiratory infections, circulatory system diseases and accidental deaths. The lack of mention of ID on death certificates highlights the importance of effective record linkage and ID reporting in health and social care settings to facilitate the government's confidential inquiry into causes of death in this population.     

Incidence of dementia in older adults with intellectual disabilities

Dementia may be more common in older adults with intellectual disability (ID) than in the general population. The increased risk for Alzheimer's disease in people with Down syndrome (DS) is well established, but much less is known about dementia in adults with ID who do not have DS. We estimated incidence rates from a longitudinal study of dementia in older adults with ID without DS and compared them to general population rates. 222 participants with ID without DS aged 60 years and older were followed up an average of 2.9 years later to identify those who had declined in functional or cognitive abilities. Those who screened positive had a comprehensive assessment for dementia, diagnosed using ICD 10 and DSM IV criteria. 134 participants who did not have dementia at initial assessment were alive and interviewed at follow up; 21 (15.7%) were diagnosed with dementia. Overall incidence rate for those aged ≥60 was 54.6/1000 person years (95% CI 34.1–82.3). The highest incidence rate (97.8/1000 person years) was in the age group 70–74. Standardised incidence ratio for those aged ≥65 was 4.98 (95% CI 1.62–11.67). Incidence of dementia in older people with intellectual disabilities are up to five times higher than older adults in the general population. Screening may be useful in this population given the high incident rates, particularly as more effective treatments become available. Studies to explore the underlying aetiological factors for dementia associated with intellectual disability could help to identify novel protective and risk factors.     

Attitudes and knowledge of child and adolescent mental health clinicians in relation to the psychosis risk syndrome

Aim: To evaluate the knowledge and attitudes of clinicians in a Child and Adolescent Mental Health Service in relation to the ‘At‐Risk Mental State’ concept in psychosis. Methods: A questionnaire was constructed and administered to child and adolescent mental health clinicians working in North East England. Results: Sixty‐seven per cent (n = 121) of eligible clinicians responded. Almost all the participants believed that young people ‘At‐Risk’ needed support. However, only around half felt confident in identifying this patient group. Approximately a third felt that antipsychotic medication may be useful. Some interprofessional differences were noted in relation to both knowledge and attitudes. Conclusions: Further training would be required for most health workers in this sample to feel confident in identifying the syndrome. These findings require replication in other service settings and may have implications for the implementation of a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnostic category relating to the At‐Risk Mental State.     

Queensland psychiatrists' attitudes and perceptions of adults with intellectual disability

Background Quality mental health care for adults with an intellectual disability (ID) depends upon the availability of appropriately trained and experienced psychiatrists. There have been few surveys of psychiatrists working with this population. Method This Australian study obtained psychiatrists’ attitudes to and perceptions of the mental health needs of adults with an ID. Training needs were also sought. The survey instrument used was a purposely designed, 28‐item self‐administered questionnaire featuring multiple‐choice and open‐ended questions. Results The majority of psychiatrists expressed concerns about treatment of this group, describing unmet needs. A total of 75% considered that antipsychotics were overused to control aggression, and 34% of psychiatrists were reluctant to treat adults with an ID. In total, 85% agreed that mental health in ID should be offered as a training option for psychiatric registrars, and that specialized mental health services would provide a high standard of care for this population. Conclusion Broad concerns are raised regarding pathways to mental health care for adults with an ID in Australia. An Australia‐wide training strategy needs to be developed. Partnerships between mental health, disability and community services that serve the mental health needs of this population, should actively seek to engage psychiatrists.     

Mapping the manuals of madness: Comparing the ICD‐10 and DSM‐IV‐TR using a network approach

The International Classification of Diseases and Related Health Problems (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM) represent dominant approaches to diagnosis of mental disorders. However, it is unclear how these alternative systems relate to each other when taking into account the symptoms that make up the disorders. This study uses a network approach to investigate the overlap in structure between diagnostic networks pertaining to ICD‐10 and DSM‐IV‐TR. Networks are constructed by representing individual symptoms as nodes, and connecting nodes whenever the corresponding symptoms feature as diagnostic criteria for the same mental disorder. Results indicate that, relative to the DSM‐IV‐TR network, the ICD‐10 network contains (a) more nodes, (b) lower level of clustering, and (c) a higher level of connectivity. Both networks show features of a small world, and have similar (of “the same”) high centrality nodes. Comparison to empirical data indicates that the DSM‐IV‐TR network structure follows comorbidity rates more closely than the ICD‐10 network structure. We conclude that, despite their apparent likeness, ICD‐10 and DSM‐IV‐TR harbour important structural differences, and that both may be improved by matching diagnostic categories more closely to empirically determined network structures. Copyright © 2016 John Wiley & Sons, Ltd.     

Mental health service use: a comparison of treated and untreated individuals with substance use disorders in Ontario.

OBJECTIVE: To determine the prevalence of and factors associated with mental health service use in the past year among respondents with an alcohol or other drug use disorder in a general population survey of Ontario adults. METHOD: Data were obtained from the 1990/1991 Mental Health Supplement to the Ontario Health Survey, which used the University of Michigan Composite International Diagnostic Interview (UM-CIDI). The current study examined 436 respondents aged 15-64 years who met Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria for a substance use disorder in the past year. The 82 respondents who used services for a mental health or substance abuse problem during the past year were compared with the 354 nonusers. Illness severity, disability, health beliefs and attitudes, and predisposing or enabling factors were examined in bivariate and logistic regression analyses. RESULTS: Twenty-two percent of respondents used services in the past year. Having concurrent disorders (comorbidity), troubled relationships with others, and dysfunction in main activity, feeling comfortable talking to a professional about mental health problems, being older and an urban resident, not working or being in school, and having a biological parent with an alcohol or drug problem were all associated with service use. CONCLUSIONS: The results suggest that individual determinants, such as severity of illness, disability, attitudes, and predisposing or enabling variables, all have a role in predicting service use among individuals in the general population who suffer from alcohol and other drug disorders.     

Injuries, falls and accidents among adults with intellectual disabilities. Prospective cohort study

Background Injuries are among the leading causes of death and disability in the world and a major public health concern. Falls are a common cause. Young persons with intellectual disabilities (ID) have a higher rate and different pattern of injuries than the general population, but little is known regarding adults. Methods The aim of this study was to determine the incidence and types of injuries experienced by a community‐based cohort of adults with ID (n = 511) in a 12‐month period. Face‐to‐face interviews were conducted with participants 2 years after they had first been recruited into a longitudinal study. Results Incidence of at least one injury in a 12‐month period was 20.5% (105), of which 12.1% (62) was because of falls. Incident injury was predicted by having epilepsy and not having autism. Incident fall injury was predicted by urinary incontinence, while Down syndrome reduced risk. Conclusions Adults with ID do experience a higher rate of injuries and falls when compared with the general population. The results of this study highlight this, and hence the need to work towards the development of interventions for injury and falls prevention in this population.     

Autism and intellectual disability: a study of prevalence on a sample of the Italian population

Background In 1994, the American Association on Mental Retardation with the DSM‐IV has come to a final definition of pervasive developmental disorders (PDD), in agreement with the ICD‐10. Prevalence of PDD in the general population is 0.1–0.15% according to the DSM‐IV. PDD are more frequent in people with severe intellectual disability (ID). There is a strict relationship between ID and autism: 40% of people with ID also present a PDD, on the other hand, nearly 70% of people with PDD also have ID. We believe that in Italy PDD are underestimated because there is no agreement about the classification system and diagnostic instruments. Method Our aim is to assess the prevalence of PDD in the Italian population with ID. The Scale of Pervasive Developmental Disorder in Mentally Retarded Persons (PDD‐MRS) seems to be a very good instrument for classifying and diagnosing PDD. Results The application of the PDD‐MRS and a clinical review of every individual case on a sample of 166 Italian people with ID raised the prevalence of PDD in this population from 7.8% to 39.2%. Conclusions The study confirms the relationship between ID and autism and suggests a new approach in the study of ID in order to elaborate a new integrated model for people with ID.     

Association of perceived stigma and mood and anxiety disorders: results from the World Mental Health Surveys

Objective: We assessed the prevalence of perceived stigma among persons with mental disorders and chronic physical conditions in an international study. Method: Perceived stigma (reporting health‐related embarrassment and discrimination) was assessed among adults reporting significant disability. Mental disorders were assessed with Composite International Diagnostic Interview (CIDI) 3.0. Chronic conditions were ascertained by self‐report. Household‐residing adults (80 737) participated in 17 population surveys in 16 countries. Results: Perceived stigma was present in 13.5% (22.1% in developing and 11.7% in developed countries). Suffering from a depressive or an anxiety disorder (vs. no mental disorder) was associated with about a twofold increase in the likelihood of stigma, while comorbid depression and anxiety was even more strongly associated (OR 3.4, 95%CI 2.7–4.2). Chronic physical conditions showed a much lower association. Conclusion: Perceived stigma is frequent and strongly associated with mental disorders worldwide. Efforts to alleviate stigma among individuals with comorbid depression and anxiety are needed.     

The structure of common mental disorders: A replication study in a community sample of adolescents and young adults

Previous research suggests that patterns of comorbidity of common mental disorders among adults are best reflected by a hierarchical three‐factor structure with two correlated factors (‘anxious‐misery’ and ‘fear’) summarized in a second‐order ‘internalizing’ factor and one ‘externalizing’ factor. This three‐factor structure has not been examined yet in a sample of adolescents and young adults. A representative sample of 3021 adolescents and young adults (baseline age 14–24) were prospectively followed over 10 years. Mental disorders were assessed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM‐IV) by using the standardized Munich Composite International Diagnostic Interview. Ten mental disorders (major depressive episode, dysthymia, generalized anxiety disorder, social phobia, specific phobia, agoraphobia, panic disorder, alcohol dependence, drug dependence, antisocial personality) were fitted to a series of Confirmatory Factor Analysis models using: (1) 12‐month data, and (2) lifetime data from a person‐year data set. The three‐factor model showed good fit to the observed data in our sample both when 12‐month diagnoses and lifetime‐to‐date diagnoses from a person‐year data file were used; yet the higher‐order ‘internalizing’ factor summarizing ‘anxious misery’ and ‘fear’ had to be omitted. The three‐factor model could be replicated in a sample of adolescents and young adults with the exception that the second‐order ‘internalizing’ factor was not consistent with the data. Further research is necessary to provide more complete insight into the structure of mental disorders by examining the stability of the structure of mental disorders in different developmental stages (ages) and by using a more extensive set of mental disorders. Copyright © 2009 John Wiley & Sons, Ltd.     

A pilot study of the reliability and validity of the Caregiver Activity Survey – Intellectual Disability (CAS-ID)

Background People with Down's syndrome (DS) are at increased risk of Alzheimer‐type dementia (AD) when compared to the general population. Despite AD being a serious progressive disorder, little attention has been paid to the impact of the illness on formal caregivers. In the general population, the Caregiver Activity Survey (CAS) is used to measure time spent by family caregivers assisting people with AD in their day‐to‐day activities of living. In order to plan appropriate models of health and social care effectively for people with AD and DS, it is imperative that the care requirements of individuals at different stages of dementia are realized. An amended version of this survey, the Caregiver Activity Survey – Intellectual Disability (CAS‐ID), was developed and tested for use by professional caregivers in the present study. Methods The CAS‐ID was administered to 30 people with DS and their caregivers. Convergent validity was tested by comparing the results of the CAS‐ID to other validated tests for cognitive and functional impairment in individuals with DS. Test–retest and inter‐rater reliability were investigated. Results The final version of the CAS‐ID consists of eight items: dressing, bathing/showering, grooming, toileting, eating and drinking, housekeeping, nursing care‐related activities, and supervision/ behaviour management. The scale had excellent test–retest reliability, and correlated strongly with the Down Syndrome Mental Status Examination (DSMSE; r = ?0.770), the Test for Severe Impairment (TSI; r = ?0.881) and the Daily Living Skills Questionnaire (DLSQ; r = ?0.855). Conclusions The present authors provide preliminary evidence for the validity and reliability of the CAS‐ID. This instrument offers a means of identifying and measuring care and resources requirements as this population experiences symptoms of dementia. Such information may help assist healthcare professionals in planning supports and services to address the care challenges evidenced at different stages of the disease process.     

Risk of mental disorders in subjects with intellectual disability in the Lundby cohort 1947–97

The Lundby Study is a prospective cohort study, which has followed a Swedish unselected community sample between 1 July 1947 and 1 July 1997. The aim was to study the risks of mental morbidity and different DSM-IV disorders in subjects with intellectual disability (ID) in the Lundby cohort between 1 July 1947 to 30 June 1997. The diagnosis of ID was re-evaluated according to DSM-IV in subjects who had been considered to have ID between 1947 and 1997. Multiple sources of information were used to obtain best estimate consensus diagnoses of mental disorders. The relative risk of mental disorder was 1.34 in subjects with ID as compared with the reference group. Dual diagnosis was more prevalent in mild ID than in moderate ID. No subject with severe ID was diagnosed with mental disorder. The cumulative incidence of any mental disorder in subjects with ID was 44%. The most common DSM-IV diagnoses were: Mood Disorders (11.5%), Anxiety Disorders (11.5%), Schizophrenia and Other Psychotic Disorders (8%), Mental Disorder NOS Due to a General Medical Condition (8%), Dementia (3.8%) and Alcohol Abuse (1.9%). Mental disorders were more common in subjects with ID than in the reference group.     

Schizophrenia-spectrum psychoses in people with and without intellectual disability

Background Although there is an increased risk of schizophrenia‐spectrum psychoses (SSP) in people with intellectual disability (ID), there is a paucity of research evidence into clinical presentation of the disorder in comparison with research into SSP in people without ID. Aims The aims of the study were to compare clinical, functional, and social factors in patients with mild ID (ICD‐10: F70) and SSP (ICD‐10: F20–9) attending a specialist mental health service for people with ID, with a control group of patients without ID but with SSP attending a generic adult mental health (GAMH) outpatient clinic. Method A total of 106 patients with SSP (53 with ID and 53 from GAMH) were assessed on psychopathological symptoms, functioning scales and quality of life. They were compared using chi‐squared and regression analysis where appropriate. Results People with ID and SSP appear to be more debilitated by the co‐occurring disorder than those with the same disorder but without ID. Increases in observable psychopathology and ‘negative’ schizophrenic symptoms, and decreased functional abilities were observed in the group with ID when compared to the GAMH group. The clinical implications of these findings are discussed.     

Experience of child and adolescent mental health clinicians working within an at-risk mental state for psychosis service: a qualitative study

Aim: To qualitatively examine the common experiences of child and adolescent mental health clinicians working with adolescents suspected of having an ‘at‐risk mental state’ (ARMS) for psychosis. Methods: A semistructured interview was conducted with six experienced child and adolescent mental health clinicians working in North East England. Results: A thematic analysis of clinicians' experiences indicated that the identification and management of an ARMS within this patient group is particularly complex. In terms of treatment options, approaches that promoted social inclusion were favoured, but the use of antipsychotic medication was perceived as a ‘last resort’, requiring serious consideration. Clear guidelines and an overall consensus were judged to be lacking in terms of coordinating care and multi‐agency working practices. Conclusions: Establishing a formalized care pathway that also incorporates regular training and supervision may be required by this and other clinical services working with adolescents suspected of having an ARMS. Improved identification, a firmer evidence base regarding treatment practices and clear guidelines are required for this age group. This need will become more urgent should a psychosis risk syndrome be included as a diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐V).     

Psychiatric Disorders in Outpatients With Borderline Intellectual Functioning: Comparison With Both Outpatients From Regular Mental Health Care and Outpatients With Mild Intellectual Disabilities

Objective:

In the Netherlands, patients with borderline intellectual functioning are eligible for specialized mental health care. This offers the unique possibility to examine the mix of psychiatric disorders in patients who, in other countries, are treated in regular outpatient mental health care clinics. Our study sought to examine the rates of all main Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, Axis I psychiatric diagnoses in outpatients with borderline intellectual functioning of 2 specialized regional psychiatric outpatient departments and to compare these with rates of the same disorders in outpatients from regular mental health care (RMHC) and outpatients with mild intellectual disabilities (IDs).

Method:

Our study was a cross-sectional, anonymized medical chart review. All participants were patients from the Dutch regional mental health care provider Rivierduinen. Diagnoses of patients with borderline intellectual functioning (borderline intellectual functioning group; n = 235) were compared with diagnoses of patients from RMHC (RMHC group; n = 1026) and patients with mild ID (mild ID group; n = 152).

Results:

Compared with the RMHC group, psychotic and major depressive disorders were less common in the borderline intellectual functioning group, while posttraumatic stress disorder and V codes were more common. Compared with the mild ID group, psychotic disorders were significantly less common.

Conclusion:

Mental health problems in people with borderline intellectual functioning may not be well addressed in general psychiatry, or by standard psychiatry for patients with ID. Specific attention to this group in clinical practice and research may be warranted lest they fall between 2 stools.     

Mental Health Problems in Adults With Down Syndrome and Their Association With Life Circumstances

This study focused on current life circumstances, previous life events, and engagement with productive and enjoyable activities. It examined the association of these variables with mental health problems and mood in a cohort of young adults with Down syndrome. Participants were 49 adults with Down syndrome (age range 20–31 years) and their parents/carers. Adults with Down syndrome completed standardized language assessments, were screened for possible mental health disorders by a psychologist using the Mini Psychiatric Assessment Schedule for Adults with a Developmental Disability, and/or were seen by a psychiatrist with expertise in dual diagnosis. Parents/carers completed measures of adaptive behavior, life events, mood, participation in activities, and psychosocial engagement with these activities. Fifteen participants (30.6%) received a psychiatric diagnosis of a mental health disorder, of which 7 were diagnosed with Depression (14.3% of the sample). Analysis of differences between 3 groups—those without a diagnosis, those with a diagnosis of Depression, and those with a mental health disorder that was not Depression—identified few differences. Although groups did not differ on the participation measure, there was a significant difference between those with no diagnosis and those with a diagnosis of Depression with respect to psychological engagement. Depressed adults were less engaged in their daily activities.     

Heart rate recovery after the 10-m incremental shuttle walking test in older adults with intellectual disabilities

Heart rate recovery (HRR) after exercise is an independent predictor for cardiovascular and all-cause mortality. To investigate the usefulness of HRR in cardiorespiratory exercise testing in older adults with intellectual disabilities (ID), the aims of this study were (a) to assess HRR in older adults with ID after the 10-m incremental shuttle walking test (ISWT) and (b) its association with personal characteristics (gender, age, distance walked on the ISWT, level of ID, genetic syndrome causing ID, autism, behavioral problems, and peak heart rate (HRpeak)). HRR was assessed after the 10-m incremental shuttle walking test in 300 older adults (>50 years) with borderline to profound ID. HRR was defined as the change from HRpeak during the ISWT to heart rate measured after 1, 2, 3, 4, and 5 min of passive recovery. The largest decrease in heart rate was in the first minute of recovery leveling off toward the fifth minute of recovery. An abnormal HHR (≤12 bpm) was seen in 36.1% of the participants with Down syndrome (DS) and in 30.7% of the participants with ID by other causes. After the fifth minute the heart rates of 69.4% of the participants with DS and of 61.4% of the participants with ID by other causes returned to resting levels. HRpeak and distance walked on the ISWT were positively related to all HRR measures. More severe ID was negatively related and having DS positively related to HRR after 3–5 min of recovery. The other characteristics were not significantly associated to HRR. HRR is a potentially useful outcome measure in cardiorespiratory fitness testing of older adults with ID with a direct, objective, and non-invasive measurement. Further research is needed to identify the relation between HRR and adverse health outcomes in this population.