Abstract
To describe the occurrence of psychiatric diagnoses in a specialist care setting in older people with intellectual disability (ID) in relation to those found in the same age group in the general population. A cohort of people with ID (n = 7936), aged 55 years or more in 2012, was identified, as was an age and sex-matched cohort from the general population (n = 7936). Information regarding psychiatric diagnoses during 2002-2012 was collected from the National Patient Register, which contains records from all inpatient care episodes and outpatient specialist visits in Sweden. The mean age at the start of data collection (i.e. January 1st, 2002) was 53 years (range 44-85 years). Seventeen per cent (n = 1382) of the people in the ID cohort had at least one psychiatric diagnosis recorded during the study period. The corresponding number in the general population cohort was 10% (n = 817), which translates to an odds ratio (OR) of 1.84. The diagnoses recorded for the largest number of people in the ID cohort were 'other' (i.e. not included in any of the diagnostic groups) psychiatric diagnoses (10% of the cohort had at least one such diagnosis recorded) and affective disorders (7%). In the general population cohort, the most common diagnoses were affective disorders (4%) and alcohol/substance-abuse-related disorders (4%). An increased odds of having at least one diagnosis was found for all investigated diagnoses except for alcohol/substance-abuse-related disorders (OR = 0.56). The highest odds for the ID cohort was found for diagnosis of psychotic disorder (OR = 10.4) followed by attention deficit/hyperactive disorder (OR = 3.81), dementia (OR = 2.71), personality disorder (OR = 2.67), affective disorder (OR = 1.74) and anxiety disorder (OR = 1.36). People with ID also had an increased odds of psychiatric diagnoses not included in any of these groups (OR = 8.02). The percentage of people with ID who had at least one diagnosis recorded during the study period decreased from more than 30% among those aged 55-59 years in 2012 (i.e. born 1953-1957) to approximately 20% among those aged 75+ years in 2012 (i.e. born in or before 1937). Older people with ID seem to be more likely to have psychiatric diagnoses in inpatient or outpatient specialist care than their peers in the general population. If this is an effect of different disorder prevalence, diagnostic difficulties or differences in health care availability remains unknown. More research is needed to understand the diagnostic and treatment challenges of psychiatric disorders in this vulnerable group.
Highlights
The number of people with intellectual disability (ID) who reach older age is increasing (Haveman, 2004; Coppus, 2013; Dieckmann et al 2015)
A few studies that have focused on psychiatric diagnoses among older people with ID suggest that old age increases the risk of overall psychiatric morbidity, dementia, anxiety disorder and depression (Cooper, 1997a, b; Deb et al 2001)
All support provided by the municipality is documented in the LSS-register, which is managed by the Swedish National Board of Health and Welfare, a government agency under the Ministry of Health and Social Affairs
Summary
The number of people with intellectual disability (ID) who reach older age is increasing (Haveman, 2004; Coppus, 2013; Dieckmann et al 2015). In wider and/or younger age groups, people with ID may have a higher risk for psychiatric disorders than the general population (Bhaumik et al 2008; Nettelbladt et al 2009; Yoo et al 2012). If this can be extrapolated into older age groups is uncertain. An accurate psychiatric diagnosis for a person with ID can be difficult to make, due to e.g. communication
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