Aging and Developmental Disabilities Medical Concerns

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Aging and Developmental DisabilitiesMedical
Concerns

• Sharon Witemeyer, MD
• Continuum of Care Project
• UNM-HSC

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Aging and Developmental Disabilities

• Audience
• Direct Care Providers
• Case Managers
• Social Workers
• Behavioral Therapists
• Provider Agency Personnel

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Issues on Aging and Developmental Disabilities

• Objectives
• The participant will be able to list 3 conditions
  associated with increased mortality among
  individuals with DD
• The participant will be able to discuss 6 medical
  conditions associated with aging
• The participant will be able to access Continuum
  of Care Project to obtain further help or
  information on health issues in DD

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Introduction

• In the USA in the year 2000
• 16.3 of the population was 60 years old
• 12.4 of the population was 65 years old
• In New Mexico in the year 2000
• 15.6 of the population was 60 years old
• 11.7 of the population was 65 years old

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Aging and Developmental Disabilities

• In the 1930s life expectancy for individuals with
  DD was 18.5 years
• Today life expectancy for individuals with DD is
  66.2 years
• Life expectancy for individuals with mild DD
  approaches that of the general population

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Aging and Developmental Disabilities

• Life expectancy for individuals with DD depends
  to a large degree upon the level of involvement.
  The more severe the impairment the more likely
  they are to have a reduced (shortened) life
  expectancy.

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Aging and Developmental Disabilities

• Individuals with severe impairments have a very
  high mortality rate in the first 0-4 years of
  life.
• After age 4 years, mortality rates decline but
  are highest for individuals who are
• 1. Immobile
• 2. Unable to feed themselves
• 3. Incontinent

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Chronic Conditions 2000General Population

• Arthritis 49
• Hypertension 36
• Hearing Impairment 30
• Heart Disease 27
• Cataracts 17
• Orthopedic Problems 18
• Sinusitis 12
• Diabetes 10

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Chronic ConditionsAging DD Population

• Hypertension 21 NDS 9 DS (36)
• Heart Disease 35 NDS 27 DS
• Visual Impairment 17 NDS 70 DS (17)
• Diabetes 4.3 NDS 9 DS (10)
• Thyroid Abnormalities 10 NDS 45.5 DS

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Aging and Developmental Disabilities

• Osteoarthritis
• Osteoporosis
• Stroke
• COPD
• Aspiration

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Aging and Developmental DisabilitiesOsteoarthriti
s

• Osteoarthritis (also known as DJD degenerative
  joint disease) is an age-related disease
  involving the breakdown of the joint cartilage.
  Usual causes include
• 1. mechanical wear and tear
• 2. previous joint injury
• 3. hereditary

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Aging and Developmental DisabilitiesOsteoarthriti
s

• Joints are the places where bones meet.
  Cartilage normally covers and cushions the ends
  of the bones. After wear and tear or joint
  injury the cartilage becomes torn and frayed,
  less elastic and worn. The bones begin to rub
  together causing pain, stiffness and limitation
  of motion. Joints may become swollen or a
  grating sensation may be felt when the joints are
  moved.

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Aging and Developmental DisabilitiesOsteoarthriti
s

• Diagnosis is usually made on the basis of history
  and physical examination. The doctor may take
  X-rays to evaluate the condition of the joints
  and in some cases may perform joint aspiration.

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Aging and Developmental DisabilitiesOsteoarthriti
s - Treatment

• Medications
• Non-narcotic pain relievers (Tylenol)
• Narcotics for short term pain relief (codeine,
  oxycodone, propoxyphene)
• Nonsteroidal anti-inflammatory drugs (NSAIDS)
  like aspirin, ibuprofen, naproxen and
  prescription NSAIDS)
• Inject able corticosteroids
• Topical pain relievers (creams, rubs, sprays)

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Aging and Developmental DisabilitiesOsteoarthriti
s - Treatment

• Other treatment strategies include
• Physical therapy
• Aerobic exercise
• Maintaining normal weight/loosing weight
• Surgery

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Aging and Developmental DisabilitiesOsteoporosis

• Osteoporosis is usually defined as a reduction of
  bone mineral density per unit volume of bone. It
  is caused by reduced bone matrix.
• Osteomalacia is caused by reduced mineral
  deposition secondary to Vitamin D deficiency
• Osteopenia refers to an early form of osteoporosis

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Aging and Developmental DisabilitiesOsteoporosis

• Osteoporosis and the risk of fractures is a
  significant problem in people with developmental
  disabilities.
• There is little medical literature that
  addresses the problem. Those studies that do
  exist report increased prevalence of osteoporosis
  among female and male, young and old with
  developmental disabilities.

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Aging and Developmental DisabilitiesOsteoporosis

• Fracture rate for individuals with developmental
  disabilities is
• 1.7-3.5 times greater than the rate for the
  general population.

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Aging and Developmental DisabilitiesOsteoporosis

• Factors associated with osteoporosis in
  individuals with developmental disabilities
• 1. Immobility
• 2. Gonadal/Endocrine Dysfunction
• 3. Medications (i.e.ACM)
• 4. Small Body Size (i.e. Down Syndrome)

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Aging and Developmental DisabilitiesOsteoporosis

• Diagnosis
• DEXA determination of bone mineral
  density (BMD) is the gold standard but is not
  always possible in individuals with developmental
  disabilities because of deformity or inability to
  cooperate.
• Urinary peptides may provide an alternative in
  the future.

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Aging and Developmental DisabilitiesOsteoporosis

• Prevention
• 1.Calcium (1000-1500mg/day)
• 2.Vitamin D (400 units/day)
• 3.Weight bearing exercise
• 4.Avoid smoking and excess alcohol consumption

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Aging and Developmental DisabilitiesOsteoporosis

• Treatment
• 1. Fosamax
• 2. Didronel
• 3. Calcitonin
• 4. Estrogen in women
• 5. Androgen in men
• 6. Parathyroid hormone (Forteo) ?

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Aging and Developmental DisabilitiesStroke

• Stroke is the result of loss or reduction of the
  blood supply to the brain. There are two ways in
  which blood supply can be cut off from the brain
• 1. A clot or other particle blocks the flow of
  blood to the brain (thrombotic stroke)
• 2. A blood vessel within the brain bursts or
  leaks (hemorrhagic stroke)

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Aging and Developmental DisabilitiesStroke

• Risk Factors for Stroke
• Hypertension many hemorrhagic strokes are
  linked to high blood pressure
• Smoking
• High cholesterol
• Obesity
• Lack of exercise
• Stress

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Aging and Developmental DisabilitiesStroke

• Risk Factors for Stroke
• Age
• Race African Americans, Puerto Ricans, Cuban
  and Mexican Americans are more likely to have
  hypertension than Anglo-Americans
• Diabetes
• Heart Disease

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Aging and Developmental DisabilitiesStroke

• Early Warning Signs of Stroke
• Weakness or numbness of the face, arm, or leg on
  one side of the body
• Dimness or loss of vision, particularly in one
  eye
• Difficulty speaking or trouble understanding
  speech
• Sudden severe headache with no known cause
• Unexplained dizziness, unsteadiness or sudden
  falls, especially with any of the other signs.

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Aging and Developmental DisabilitiesStroke -
Treatment

• Medications
• Antithrombotics reduce the risk of blood clot
  formation
• Aspirin an antiplatelet drug prevents blood
  clots
• Anticoagulants Coumadin and Heparin
• Thrombolytic agents are used to treat ongoing
  acute ischemic stroke caused by an artery
  blockage.
• Surgery
• Physical, Occupational, and Speech Therapy

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Aging and Developmental DisabilitiesCOPD

• Chronic Obstructive Pulmonary Disease (COPD) is
  persistent obstruction of the airways caused by
  emphysema and/or chronic bronchitis.

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Aging and Developmental DisabilitiesCOPD

• Emphysema results from a breakdown of the walls
  of the tiny lung air sacs (alveoli) which causes
  over-inflation and a decrease in lung function.
• Chronic bronchitis is inflammation and eventual
  scarring of the lining of the bronchial tubes.
• These conditions are often found together and
  cause obstruction of airflow through the lungs.

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Aging and Developmental DisabilitiesCOPD

• Causes
• 80-90 of cases of COPD are caused by smoking!
• Other causes include frequent lung infections
  and exposure to certain industrial pollutants
• A much rarer, genetic form of emphysema is
  caused by alpha-1-antitrypsin deficiency

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Aging and Developmental DisabilitiesCOPD

• Prevention
• Dont start smoking.
• Dont smoke.
• QUIT SMOKING!!!
• Maintain overall good health habits (nutrition,
  exercise, adequate sleep.)
• Reduce exposure to air pollution.
• Vaccinations against influenza and pneumococcal
  pneumonia

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Aging and Developmental DisabilitiesCOPD

• Treatment
• QUIT SMOKING!
• Bronchodilators for reversible elements
• Antibiotics for bacterial infections
• Oxygen
• Exercise programs
• Surgery including lung transplants

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Ageing and Developmental DisabilitiesAspiration
Pneumonia

• When contents from the mouth or stomach enter the
  airway and get into the lungs they can cause
  infection or inflammation that is called
  aspiration pneumonia.
• In the general population, particles from the
  mouth frequently dribble into the airway and are
  cleared out by the bodys defenses before they
  reach the lung. Individuals with DD are at high
  risk for developing aspiration pneumonia.

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Aging and Developmental DisabilitiesAspiration
Pneumonia

• Risk factors associated with developing
  aspiration pneumonia include
• Dysphagia (swallowing difficulties)
• Gastro-esophageal reflux disease (GERD)
• Periodontal (dental) disease
• Altered level of consciousness.
• Neurological conditions (stroke, seizures)
• Other neuromuscular conditions

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Aging and Developmental DisabilitiesAspiration
Pneumonia

• Symptoms of aspiration pneumonia include
• Coughing
• Wheezing
• Intermittent fevers
• Weight loss
• Dehydration
• Rumination

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Aging and Developmental DisabilitiesAspiration
Pneumonia

• Treatment
• Antibiotics
• Supportive care
• Stop feeding
• Protection of the airway
• Positioning
• Oxygen if needed
• Nebulization treatments if needed
• Careful monitoring of the individual

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Aging and Developmental DisabilitiesAspiration
Pneumonia

• Prevention
• Changing diet consistency, texture, temperature
• Therapeutic positioning correct neck position,
  seating support, proper alignment
• Adaptive eating equipment spoons, cups,
  glasses
• Assisted eating techniques
• Non-oral/alternative eating techniques tubes
• Good oral hygiene
• Appropriate choice of medications

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COMING ATTRACTIONDATES TO BE ANNOUNCED

• Continuum of Care Project will be presenting
  further topics on Aging and Developmental
  Disabilities. These discussions will cover
  Additional topics in Physical and Mental Health,
  OT, PT, SLP Therapy, Pharmacology, Quality of
  Life, Death and Dying, Abuse and Neglect, Legal
  and Systems Issues.

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Contact Continuum of Care Project

• Telephone
• 505-272-5215
• 877-684-5259
• Address
• 2300 Menaul NE
• Albuquerque, NM 87107

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Visit our website

• http//star.nm.org/coc

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Visit our web manual

• Your Healthcare Primer for Long Term Care
• http//star.nm.org/coc/manual

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