Abstract
BackgroundThe aging population of adults with intellectual and developmental disabilities (IDD) is growing. In the general aging population, frailty is commonly used to predict adverse health outcomes, including hospital use, death, and admission to long-term care. However, existing frailty measures are less appropriate for aging persons with IDD, given their pre-existing conditions and limitations. An accumulation of deficits approach, which is now widely used to describe frailty in the general population, may be more suitable for persons with IDD. Frailty measures specific to persons with IDD have not been widely studied.MethodsUsing pre-determined criteria, a frailty index (FI) specific to persons with IDD was developed based on items in the Resident Assessment Instrument - Home Care (RAI-HC), and using the assessments of 7,863 individuals with IDD in Ontario (aged 18–99 years) admitted to home care between April 1st, 2006 and March 31st, 2014. FI scores were derived by dividing deficits present by deficits measured, and categorized into meaningful strata using stratum-specific likelihood ratios. A multinomial logistic regression model identified associations between frailty and individual characteristics.ResultsThe resulting FI is comprised of 42 deficits across five domains (physiological, psychological, cognitive, social and service use). The mean FI score was 0.22 (SD = 0.13), equivalent to 9 deficits. Over half of the cohort was non-frail (FI score < 0.21), while the remaining were either pre-frail (21 %, FI score between 0.21 and 0.30) or frail (27 %, FI score > 0.30). Controlling for individual characteristics, women were more likely to be frail compared to men (OR = 1.39, 95 % CI: 1.23–1.56). Individuals who were frail were significantly more likely to have a caregiver who was unable to continuing caring (OR = 1.86, 95 % CI: 1.55–2.22) or feeling distressed (OR = 1.54, 95 % CI: 1.30–1.83). Living with a family members was significantly protective of frailty (OR = 0.35, 95 % CI: 0.29–0.41), compared to living alone.ConclusionsUsing the FI to identify frailty in adults with IDD is feasible and can be incorporated into existing home care assessments. This could offer case managers assistance in identifying at-risk individuals. Future analyses should evaluate this measure’s ability to predict future adverse outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-015-0170-5) contains supplementary material, which is available to authorized users.
Highlights
The aging population of adults with intellectual and developmental disabilities (IDD) is growing
Almost 1 % of the population has an IDD [3, 4], which the World Health Organization defines as “a group of developmental conditions characterized by significant impairment of cognitive functions, which are associated with limitations of learning, adaptive behaviour and skills” [5]
While a consistently applied definition does not exist in the literature, frailty is generally viewed as age-related decline associated with higher risk of adverse health outcomes [16]
Summary
The aging population of adults with intellectual and developmental disabilities (IDD) is growing. Almost 1 % of the population has an IDD [3, 4], which the World Health Organization defines as “a group of developmental conditions characterized by significant impairment of cognitive functions, which are associated with limitations of learning, adaptive behaviour and skills” (page 177) [5] These conditions originate before the age of 18 years [6], with the expectation of lifelong disability.The risk of health problems is greater among persons with IDD [7], and these contribute to the widely held notion that this group experiences premature aging, where 50 years may be considered “old” [8,9,10,11,12]. A review of the literature revealed the existence of two research groups explicitly measuring frailty in this population, each using a different approach
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