People of all ages with an intellectual disability are particularly vulnerable to adverse outcomes associated with COVID-19 warns Mary McCarron, Professor of Ageing and Intellectual Disability at the Trinity Centre for Ageing and Intellectual Disability (TCAID).
Those with an intellectual disability fall into a high-risk category because they may suffer from several health conditions, have low levels of health literacy and rely on other people for care. Professor McCarron notes that the health and disability sectors are also not adequately prepared and equipped to meet their needs.
Historically this population has been subjected to attitudinal bias and prejudice that has devalued their lives and reduced their timely access to appropriate health care.
Professor McCarron stresses the need to rapidly scale up and ensure the relevant skills are in place in the health care and social care systems to ensure they have the capacity to respond to this pandemic and its consequences for people with an intellectual disability.
It is essential for family and staff caregivers, clinicians and health care workers to consider these needs in order to provide appropriate care and support for those with an intellectual disability.
Facts and Health risks for people with an intellectual disability (Source IDS TILDA 2017)
- Extremely high prevalence of multimorbidity in adults with intellectual disabilities across the entire adult life course.
- IDS-TILDA identified multimorbidity for 71% of the older intellectual disability (ID) population in Ireland.
- This is higher than rates reported in the general older population and it starts at an earlier age (59%).
- Mulitmorbidity starts earlier and increased with age:
- 63% in those aged 40–49 years to
- 72% in those aged 50–65 years and
- 86% in those aged 65 years and older.
- Prevalence of eye disease, mental health disease, endocrine disease, joint disease, hypertension, cancer and stroke increased with age for people with ID.
- Multimorbidity is highest among those with more severe levels of intellectual disability.
- Having ?4 chronic conditions was associated with Down syndrome.
- Older people with Down syndrome are particularly at risk many having pre-existing cardiovascular and respiratory problems, confounded by a 55% risk of dementia in those age 55+ increasing to 88% in those age 65 years and older
- Women with ID are at a higher risk of multimorbidity than men.
- The most prevalent multimorbidity pattern was mental health/neurological disease.
- The concept of social distancing may be difficult for some people with ID to understand and adhere to.
- Mental health concerns are more significant for older people with ID.
- Over half (52%) reported a diagnosis of an emotional or mental health condition
- 15% of this population have anxiety
- Comparable rates of depression were double that of the general population (10% versus 5%)
- The potential impact in terms of worry and disruption due to COVID-19 is therefore a particular risk to the emotion and mental health well-being of this population.
- Older people with ID have smaller social networks and fewer social supports than the general population.
- They do not have partners or children of their own to support them at times of crisis.
- Disruption to their already restricted networks and supports due to COVID-19 places them at greater risk of social isolation and loneliness, and worse psychological outcomes.
- Many who live at home with family co-reside with ageing parent carers, who themselves are amongst the higher risk groups for Covid-19.
- Restrictions on visiting and visitors will often not be understood, increasing risk and sense of social isolation
- Compounding the raised physical, psychological and social risks identified, many older people with ID have great difficulty accessing and understanding information about risks and prevention advice such as social distancing of COVID-19.
- Very few can access to the internet and find information without support
- The vast majority have difficulty reading
- Many will need increased assistance/support to understand and adhere to guidelines on handwashing
- Such information must be provided in accessible easy- to-read materials, videos and be reinforced by direct support from family, staff, health professionals and others.
- For example: