Gerentology Nursing - Issues of Aging Adults with Disabilities

This essay delves into the evolving landscape of gerontology nursing, specifically focusing on the increasing population of aging individuals with intellectual disabilities. It highlights the significant improvements in healthcare that have extended lifespans, leading to a growing subgroup of older adults with intellectual disabilities, a demographic often overlooked by existing care frameworks. The paper addresses the unique challenges these individuals face, including health issues, housing concerns, and social obstacles such as discrimination and lack of access to education. Furthermore, the essay explores potential interventions and changes within the healthcare system, emphasizing the role of nurses in improving the quality of life for this population. It discusses interventions like nutrition, occupational therapy, and light therapy, and suggests broader system-level improvements such as preventative screening, educational programs, and support for housing to better meet the needs of aging adults with intellectual disabilities.

Running head: GERENTOLOGY NURSING
Aging Individuals with Intellectual Disabilities
Author Name(s)
Institution
Author Note

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Abstract
Transition in life involves moving from young age all the way to older age. With this, the
transition affects everyone both people with disabilities and those without disabilities. As the
population of the aged adults dramatically increase, so does the population of aged adults with
intellectual disabilities. Unlike in the past centuries where a few people made it to old age,
improvement in healthcare has helped people to even grow past 80 years old. Thus, the society is
seeing an emerging subgroup of people with intellectual disabilities who are now able to reach
old age. Again, these people are also facing challenges as there are few or no frameworks which
specifically target their needs. This paper would be a discussion of the issue of the transition of
older adults to care facilities and issues faced by older adults with intellectual disabilities.
Keywords: older adults; retirement; Quality of Life; active ageing, healthy ageing,
intellectual disability, health

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Aging Individuals with Intellectual Disabilities
The improvement of health has created positive impacts on the world as both the general
population and the people with disabilities are able to live longer than experienced in the past.
While such an outcome is good in modern society, there is an emerging subgroup of people who
are older adults with limited disabilities. One problem with most of the frameworks is that they
either provide solutions for people with disabilities, or older adults. The purpose of this paper is
to discuss some of the issues faced by this group. The paper will also discuss some of the
interventions and steps that healthcare system can implement to take care of their needs.
Sub Population: Aging Individuals with Intellectual Disabilities
The world is experiencing dramatic changes in policies and practices dealing with adults
with Intellectual Disabilities (ID) over the past few decades (Innes, McCabe, & Watchman,
2012). The important aspect of these changes is that they have led to a shift from where people
with ID lived in segregated residential care into a person-centered approach. With these changes,
even people with ID have longer life expectancy just like the rest of the population. From the
report by WHO, there are more than 1 billion people living with a disability (World Health
Organization, 2011). Reports from international studies have estimated that there are 4.94 people
1000 adults living with ID globally (Maulik, Mascarenhas, Mathers, Dua, & Saxena, 2011). In
Canada, there are estimated to be between 1-3% adults with ID (Sullivan et al., 2011). In overall,
aged adults with ID is a sub-population of aged “healthy” persons most of them having ID in the
late years of their lives.
Literature Review
The increased care and longevity among people with disabilities has led to a sub-
population of people aging with ID (Campbell & Putnam, 2017). For instance, while analyzing

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literature about individuals with Down syndrome, Coppus (2013) stated that their life expectancy
has increased from 56 years where it was in 1990s. While looking at the overall global
population, research has shown that women have a longer life expectancy than men (Zarulli et
al., 2018). When the same trend was tested in people with among older adults with DS, Stancliffe
et al (2012) also found that women with DS lived longer than men with DS.
Understanding people aging with ID requires one to look through the historical, political,
and social context of their lives. A model provided in Heller and Harris (2012) identifies positive
aging outcomes as the maintenance of health and body functioning and active engagement.
However, older adults with ID are vulnerable to other conditions that affect their aging through
poor health, need for support, fewer life resources. For instance, in the study of conducted using
machine learning, the results showed that people with down syndrome experience premature
aging (Cole et al., 2017). This premature aging can cause the individual to retire early which also
means they will move to supported living and early age.
Studies exploring premature aging in people with ID have attributed the cause to the
existence of multiple morbidities. In a study aimed at exploring somatic healthcare consumption
patterns in people living with ID in Sweden, the study showed that even at a younger age, people
with ID used healthcare more than the general population (Sandberg, Ahlström, Axmon, &
Kristensson, 2016). The study showed a decreasing pattern at an older age. However, this was
due to barriers and other difficulties in accessing healthcare services (Sandberg et al., 2016). The
work of Emerson and Baines (2011) states that most of the conditions in people with ID remain
untreated or even undetected. Confirming this with the study of (Sandberg et al., 2016), these
problems can remain undetected especially due to problems of accessing healthcare services.

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When looking at the social determinants of health, for example, it is a fact that
individuals with ID belong to a disadvantaged group that highly suffer health discriminations
(Emerson & Hatton, 2013). While such factors are key players to their poor health, these people
are also impacted by other health conditions that come with aging. Their issues are even made
worse by the fact that the conditions associated with aging appear in individuals with ID at an
earlier age than with the rest of the population.
The Issues of Aging Within This Sub-Population
Though there are numerous studies focusing on aging individuals with ID, only a few of
them deals with a specific need such as depression in older people with ID (Jahoda et al., 2015).
However, looking at the existing literature, some of the needs of these older adults involve
personal health, lack of health resources, poor social service, lack of economic resources, and
multiple obstacles in their lives (Johansson, Björne, Runesson, & Ahlström, 2017) In terms of
health, people living with ID live a vulnerable life due to various issues of health, housing, and
care among others due to the difficulties they experience (Johansson et al., 2017). While looking
at issues of health, studies have shown that have various risks to their lives which are the major
cause of their hospitalization. For instance, in a study conducted on 7936 people above aged 55
years who were registered with ID, the results showed that individuals with ID had 41% higher
chances of seeking care due to foreign objects entering their natural orifice when compared with
the general population (Axmon, Ekwall, & Ahlström, 2019). The study also showed that these
people were 92% highly likely to fall for drug poisoning, biological substances and
medicaments(Axmon et al., 2019).
When it comes to housing for older persons with ID, it has been estimated that about
more than 100,000 - 120,000 lack support in affordable housing services (Association for

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Community Living[CACL], 2018). There is also evidence that older adults with intellectual
disabilities have a higher likelihood of homelessness when compared with the rest of the
population. In a study conducted by Mercier and Picard (2011), the results of the study showed
that individuals with ID had various problems some which included short periods of
homelessness. There were also cases with some individuals with ID experiencing chronic
homelessness(Mercier & Picard, 2011). The work of Thudalikunnil (2016) enlighten that in cases
where even closest family members of aged persons with ID are neglecting them.
In most case, the needs touching on social service have been interrelated with health
needs. According to literature Ouellette-Kuntz, Martin, & McKenzie (2015), older individuals
with ID face other obstacles such as following with routine medication or even accessing
recreation and leisure activities. In another self-reported study conducted in McCausland et al.
(2010), the authors found that older individuals with ID reported some ‘unmet needs’ such as
independence in managing their finances and lack of basic education.
Nurses Intervention and System Implication on Helping Individuals with ID
The effective nurse interventions are those aimed at improving the quality of life (QoL).
From the work of Fesko, Hall, Quinlan, and Jockell (2012), QoL in gerontologic concepts is
more about active and healthy. Walker (2015) further explains that QoL is required life
satisfaction in all aspects of physical, material, psychosocial, and existential part of life which
helps someone to pursue productive aging. However, for all these to be a reality, both nurses and
healthcare system would need to play some roles.
Nurse Interventions
There are different interventions in palliative care that nurses can engage to improve the
QoL for persons with ID. For instance, nutrition interventions can help in providing dietary care

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to the population (Carrier, West, & Ouellet, 2009). In particular, Carrier et al. (2009) advocate for
a diet that is respectful to the person’s preference and culturally appropriate. Just like nutrition,
occupational therapy (OT) can also help in improving QoL for older persons with ID (Leland &
Elliott, 2012). Apart from preventing deterioration, OT is cost effecting and most people can
afford. One diverse intervention involves using light. There is evidence that simple Bright Light
Therapy (BLT) improves quality of sleep thus improving the QoL(Hermans, Soerokromo, and
Evenhuis, 2017). Altogether, a combination of different inteventions can be helpful in improving
aged adults QOL.
Changes to the Health Care System
Firstly, there are different strategies and intervention that can help in preventing frailty
and deterioration of QoL. For the governments and healthcare systems, an improvement in
housing and supporting education for individuals with ID can help in improving their QoL. Both
the government and healthcare systems can come up with preventative screening intervention
which can help gather information for coordinating care (Brown, Jacobstein, Yoon, Anthony, &
Bullock, 2016). In addition, training programs which are planned and coordinated geared
towards prevention, screening, education on healthy living, orientated on the proper use of
psychotropic medication is feasible in creating awareness promoting QoL (Brown et al., 2016).
Given that everyone is aware they are moving through a trajectory to old age, even people aging
people with ID have a vivid idea of what is awaiting after the retirement, and education and
training will help to prepare them.
Conclusion
With the increasing population of aged people with ID, it would be important that care
interventions would also be updated to cope well with the changing demands. Section II of this

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paper intended to cover the issues of older people with intellectual disability as the emerging
population. Discussion of the issues faced by this group included health issues, housing and other
problems such as discrimination and lack of education. Finally, the paper discussed some of the
nurses’ interventions and system care changes which can help improve their quality of care.

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