Older people with intellectual disability and affective and anxiety disorders: Comorbidities, healthcare utilisation, pharmacotherapy and frailty factors requiring support and social services

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El Mrayyan N. Older people with intellectual disability and affective and anxiety disorders: Comorbidities, healthcare utilisation, pharmacotherapy and frailty factors requiring support and social services. Lund: Lund University: Faculty of Medicine, 2020. 78 p. (Lund University, Faculty of Medicine Doctoral Dissertation Series; 2020:135).

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TY - THES

T1 - Older people with intellectual disability and affective and anxiety disorders: Comorbidities, healthcare utilisation, pharmacotherapy and frailty factors requiring support and social services

AU - El Mrayyan, Nadia

N1 - Defense details Date: 2020-12-11 Time: 13:00 Place: Health Science Centre, Baravägen 3 i Lund. External reviewer(s) Name: Northway, Ruth Title: Professor Affiliation: University of South Wales, Cardiff.

PY - 2020

Y1 - 2020

N2 - AbstractBackground: Affective and anxiety disorders have a higher occurrence in older people with intellectual disability (ID) than in the general population. However, there is a lack of research into this ageing group from the point of view of their health panorama, use of medicines, healthcare utilisation and social welfare support. This thesis is part of a Swedish national population project on health, mortality, healthcare and social welfare utilisation among older people with ID.Aim: The main aim of the thesis was to investigate comorbidities, healthcare utilisation and pharmacotherapy in older people with ID, compared to older people from the general population, diagnosed with affective and/or anxiety disorders. A further aim was to investigate, within the ID group, the association between frailty factors and use of support and social services provided through Swedish disability regulations.Methods: All of the studies have a longitudinal design, based on Swedish national registries during an 11-year period. The ID cohort was a sample from the national study population, aged at least 55 years and alive at the end of 2012 (n=7,936), and a control group of the same size was matched by birth year and sex from the general population. Studies I–III investigated those in both cohorts with at least one affective disorder (n=918) and/or anxiety disorder (n=825) who visited specialist healthcare, examining diagnoses, healthcare utilisation and pharmacotherapy in these subgroups. Study IV focused on the ID group only (n=871), examining their frailty factors and use of support and social services.Results: Older people with ID were more likely to have other comorbidities, to visit inpatient healthcare and to be prescribed drugs such as anxiolytics, compared to older people in the general population with affective and/or anxiety disorders (Studies I-III). The most common psychiatric comorbidities in the ID group were unspecified or other mental disorders. Concerning somatic comorbidities, they were more likely to have neurological problems, injuries and falls (Study I). The ID group was more likely to have inpatient and unplanned healthcare visits to both psychiatric and somatic healthcare (Study II). Those with affective and/or anxiety disorders in the ID group were more likely to be prescribed anxiolytics and GABA agonists (Study III). Those having more than 12 visits to healthcare and having multimorbidity were less likely to live in residential arrangements, the opposite was found for polypharmacy and moderate or severe levels of ID compare to those without (Study IV).Conclusion: The results verify that older people with ID and with affective and/or anxiety disorders have comprehensive and complex needs for healthcare, treatment and social services, which puts exceptionally high demands on promoting healthy ageing for this target group. From the results of these studies, as well as from the increasing number of ageing people with ID in all developed countries in the world, there is an urgent need to develop specific medical guidelines for health surveillance and structured care programmes for this frail group of older people. Preventive interventions for affective and anxiety disorders need to focus on communication strategies and tools to foster healthy ageing and person-centred healthcare. Implementation of Peplau's model of the nurse client relationship and EU policy of healthy ageing may improve the quality of care.

AB - AbstractBackground: Affective and anxiety disorders have a higher occurrence in older people with intellectual disability (ID) than in the general population. However, there is a lack of research into this ageing group from the point of view of their health panorama, use of medicines, healthcare utilisation and social welfare support. This thesis is part of a Swedish national population project on health, mortality, healthcare and social welfare utilisation among older people with ID.Aim: The main aim of the thesis was to investigate comorbidities, healthcare utilisation and pharmacotherapy in older people with ID, compared to older people from the general population, diagnosed with affective and/or anxiety disorders. A further aim was to investigate, within the ID group, the association between frailty factors and use of support and social services provided through Swedish disability regulations.Methods: All of the studies have a longitudinal design, based on Swedish national registries during an 11-year period. The ID cohort was a sample from the national study population, aged at least 55 years and alive at the end of 2012 (n=7,936), and a control group of the same size was matched by birth year and sex from the general population. Studies I–III investigated those in both cohorts with at least one affective disorder (n=918) and/or anxiety disorder (n=825) who visited specialist healthcare, examining diagnoses, healthcare utilisation and pharmacotherapy in these subgroups. Study IV focused on the ID group only (n=871), examining their frailty factors and use of support and social services.Results: Older people with ID were more likely to have other comorbidities, to visit inpatient healthcare and to be prescribed drugs such as anxiolytics, compared to older people in the general population with affective and/or anxiety disorders (Studies I-III). The most common psychiatric comorbidities in the ID group were unspecified or other mental disorders. Concerning somatic comorbidities, they were more likely to have neurological problems, injuries and falls (Study I). The ID group was more likely to have inpatient and unplanned healthcare visits to both psychiatric and somatic healthcare (Study II). Those with affective and/or anxiety disorders in the ID group were more likely to be prescribed anxiolytics and GABA agonists (Study III). Those having more than 12 visits to healthcare and having multimorbidity were less likely to live in residential arrangements, the opposite was found for polypharmacy and moderate or severe levels of ID compare to those without (Study IV).Conclusion: The results verify that older people with ID and with affective and/or anxiety disorders have comprehensive and complex needs for healthcare, treatment and social services, which puts exceptionally high demands on promoting healthy ageing for this target group. From the results of these studies, as well as from the increasing number of ageing people with ID in all developed countries in the world, there is an urgent need to develop specific medical guidelines for health surveillance and structured care programmes for this frail group of older people. Preventive interventions for affective and anxiety disorders need to focus on communication strategies and tools to foster healthy ageing and person-centred healthcare. Implementation of Peplau's model of the nurse client relationship and EU policy of healthy ageing may improve the quality of care.

KW - Ageing

KW - Intellectual disability

KW - Affective disorders

KW - Anxiety disorders

KW - Healthcare

KW - Social Services

KW - Drugs

KW - Frailty factors

M3 - Doctoral Thesis (compilation)

SN - 978-91-8021-002-7

T3 - Lund University, Faculty of Medicine Doctoral Dissertation Series

PB - Lund University: Faculty of Medicine

CY - Lund

ER -