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Adults with intellectual and developmental disabilities (IDD) are at a greater risk of developing high cholesterol and cardiovascular disease. We examined whether physical inactivity, obesity, and diabetes were predictive of reported high cholesterol and whether there were any mediating effects of diabetes on the relationship between obesity and high cholesterol in 1,618 adults with IDD across five years. Results suggest that obesity and diabetes were significantly associated with high cholesterol after adjusting for age, sex, and residence type with a partial mediator effect of diabetes in the relationship between obesity and high cholesterol across all time points. Further research is needed to explore the causal mechanisms behind the relationships between obesity, diabetes, and high cholesterol.

A better understanding of the factors associated with depression and anxiety in people with intellectual and developmental disabilities (IDD) is needed to provide guidelines for service providers, clinicians, and researchers as well as to improve the diagnostic process. The current study used a longitudinal dataset to explore demographic, health, and psychosocial risk factors of anxiety and depression in adults with IDD. Women were more likely to have depression while older adults, people with autism, and people with hearing impairments, were more likely to have anxiety. Chronic health conditions were associated with both anxiety and depression, while changes in stressful life events were associated with an increased risk of anxiety. Clinical and research contributions are discussed.

Background: Despite the enactment of disability laws/policies in India, research shows that caregivers of adults with intellectual and/or developmental disabilities experience inadequate formal supports/services due to dissemination barriers and lack of awareness about them. To address discrepancy between caregivers' support needs and the professionals' understanding of their needs, the study proposed to conduct a caregiver needs assessment so that culturally‐tailored programs are developed. Method: A strengths‐based mixed methods needs assessment was conducted with a convenience sample of 100 caregivers in Hyderabad, India. One hundred caregivers completed the survey and 15 caregivers participated in semi‐structured interviews. Results: Caregivers needed more and improved formal supports/services, particularly from the government. Caregivers faced systemic and attitudinal barriers, and personal impediments to accessing them. Needs differed by care recipients' intellectual disability level, gender, and intellectual disability related conditions. Conclusions: Researchers, service providers and policymakers need to adopt innovative strategies to improve formal supports/services access. [ABSTRACT FROM AUTHOR]

Social participation has been linked to healthy aging, yet little is known about social participation during extended periods of time for adults with intellectual and developmental disabilities. The social participation of 777 adults with intellectual and developmental disabilities (aged 18-77 years), during a 4-year period, was examined. Sociodemographic, physical, and behavioral health-related correlates of engagement in social participation were investigated. Findings indicated that the majority of adults with intellectual and developmental disabilities engaged in at least a moderate level of social participation during the 4-years. Employment status, physical health, and Special Olympics participation were associated with a higher level of social participation. Findings have implications for supports and services seeking to promote social participation opportunities for adults with intellectual and developmental disabilities. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the prevalence of falls and risk factors for falls in 1,515 adults (greater than or equal to 18 years) with intellectual disability using baseline data from the Longitudinal Health and Intellectual Disability Study. Nearly 25% of adults from the study were reported to have had one or more falls in the past 12 months. The prevalence of falls increased with advancing age. A series of univariate and multivariate logistic regressions were performed to identify risk factors for falls in the full sample and in subsamples. The risk factors for falls in adults with intellectual disability are being female, having arthritis, having a seizure disorder, taking more than 4 medications, using walking aids, and having difficulty lifting/carrying greater than 10 lb.

The present study examined the degree to which residential characteristics and social factors are associated with mortality, after controlling for personal characteristics, among adults with intellectual disabilities who have resided in nursing homes (facilities providing skilled care and related services) at baseline in the Chicago area. Initial assessments were conducted on 330 residents, and 2 follow ups were performed over 10 years. Seventy-one residents had died by the end of the study. The variables examined included personal characteristics of age, gender, intellectual level, health, and adaptive behavior; residential characteristics of type of residence, size of facility, attractiveness of physical environment (cleanliness, conditions, and aesthetic appeal), and diversity of physical environment (personalization of residents' rooms and distinctiveness of all living spaces); and social factors of family involvement and community integration. The results indicated, beyond age, adaptive behavior, and health, that size of residences, residential characteristics, and social factors are related to mortality.

The health status of 206 female caregivers supporting adults with intellectual and developmental disabilities at home was investigated using objective (i.e., presence of chronic health conditions and activity limitations) and subjective (i.e., self-perceived health status) health measures compared with those of women in the general population in 2 age groups: middle age (Ages 40-59 years) and older ages (greater than or equal to 60 years). Prevalence of arthritis, high blood pressure, obesity, and activity limitations for the caregivers in both age groups was significantly higher than that for women in the general population. Middle-age caregivers reported a higher prevalence of diabetes and high blood cholesterol than their age peers from the general population. Despite the potential health challenges, the caregivers generally perceived their health better than that of women in the general population. Older caregivers' perceptions on their psychological well being, however, appeared to an exception. Implications regarding potential health risks for caregivers and residential services for persons with intellectual and developmental disabilities are discussed.

Attitudinal and psychosocial outcomes of a fitness and health education program for adults with Down syndrome were examined. Participants were 53 adults with Down syndrome ages 30 years and older (29 females, 24 males, M age = 39.72 years) who were randomized into a training (n = 32) or control group (n = 21). The training group participated in a 12-week, 3 days per week, exercise and health education program. Outcome measures included attitudes towards exercise (cognitive-emotional barriers, outcomes expectations, and performance self-efficacy) and psychosocial well-being (community integration, depression, and life satisfaction). Compared to controls, the training group showed significant changes in attitudes towards exercise, including increased exercise self-efficacy, more positive expected outcomes, fewer cognitive-emotional barriers, improved life satisfaction, and marginally lower depression.

The effectiveness of a person-centered later-life training program designed to teach 60 older adults with mental retardation about later-life planning issues and to increase their participation in choice-making was examined. Participants made more choice over time than did a control group and 87 percent met or partially met their goals. (Contains references.) (Author/CR)

Examined were the impact of exercise barriers and carer attitudes regarding exercise outcomes on the exercise participation of adults with Down syndrome (DS). The sample included 44 adults age 30 years and older with DS and mild to moderate intellectual disability and their carers (family members or staff). Measures included personal characteristics of the adults with DS (age, level of adaptive behavior, and health status), carer perceived outcomes of exercise for people with DS, socio-emotional barriers, and access barriers to exercising. A regression analysis was conducted with exercise frequency as the dependent variable and the above measures as the independent variables. The significant determinants of exercise participation were carers' perceived outcomes of exercise for persons with DS and access barriers. When carers perceived greater benefits of exercise and when there were fewer access barriers, the adults with DS were likely to exercise more frequently. Persons with DS were more likely to report access barriers than were informants. The results reinforce the need to improve access to exercise facilities and equipment and to increase carers' awareness of the importance of exercise for adults with DS. KEYWORDS. Down syndrome, exercise determinants, social-cognitive model

Predictors of benefits derived from participating in support groups for families of persons with mental illness were examined A survey of 131 families indicated that social support resources outside the group, as well as support received from and provided by the group, were associated with information acquired by the participant. Improved relationships with family and the ill relative were predicted by the participant's health and provision of support in the group.

Health‐promoting behaviors have been shown to enhance the quality of life across diverse populations. In this study, we examined the indirect effects of several health‐promoting behaviors on the relationship between parenting stress and health‐related quality of life in mothers of children with cerebral palsy (CP). A convenience sample of Korean mothers (N = 180) of children aged 10 months to 12 years with CP was recruited from clinical and school settings. Health‐promoting behaviors were measured using the health‐promoting lifestyle profile II, which is comprised of six subscales: health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations, and stress management. Multiple mediation analyses were conducted to examine the mediating role of these behavioral categories. Spiritual growth (β =.56, p <.05) had an indirect effect on the relationship between parenting stress and physical health‐related quality of life while spiritual growth (β = −1.00, p <.01) and stress management (β = −.80, p <.05) were found to mediate the association between parenting stress and mental health‐related quality of life. The findings of multiple mediation analyses provide evidence of the influence of specific health‐promoting behaviors on health‐related quality of life, thereby informing the development of intervention programs for mothers of children with disabilities. [ABSTRACT FROM AUTHOR]

This study examined the impact of social support from grandparents on the well-being of mothers of persons with intellectual disabilities. Also, it described the social support functions served by the grandparents across the lifespan and the predictors of this support. The subjects included 120 mothers of a child with moderate to profound intellectual disability living in the family homes. Surveys and interviews conducted in home asked about characteristics of the child (age, level of intellectual disability, physical health, maladaptive behavior) and mother (age, minority status, and socio-economic status); support received other than from grandparents (unmet needs, other informal supports) and grandparent support (instrumental and emotional), and maternal depression. The key variables predicting maternal depression were the mother's younger age and poorer physical health and less emotional support from the grandparents. Grandparents of younger children provided more instrumental support than did grandparents of adult children. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: Website: ] KEYWORDS. Grandparents, social support, mental retardation

AbstractPurposeMaterials and methodsResultsConclusions\nImplication for rehabilitationTo determine if falls perceived as significant by lower limb prosthesis (LLP) users were associated with fall circumstances and/or consequences.The circumstances and consequences of LLP users’ most significant fall in the past 12-months were collected using the Lower Limb Prosthesis User Fall Event Survey. Participants rated fall significance from 0 (not significant) to 10 (extremely significant), which was then dichotomized into “low” and “high”. Binary logistic regression was used to assess associations between fall significance and fall circumstances and consequences.Ninety-eight participants were included in the analysis. Five fall consequences were associated with greater significance: major injury (OR = 26.7, 95% CI: 1.6–459.6, p = 0.024), need to seek medical treatment (OR = 19.0, 95% CI: 1.1–329.8, p = 0.043), or allied-health treatment (OR = 18.2, 95% CI: 2.3–142.4, p = 0.006), decreased balance confidence (OR = 10.9, 95% CI: 2.4–49.3, p = 0.002), and increased fear of falling (OR = 7.5, 95% CI: 2.4–23.8, p = 0.001), compared to two fall circumstances: impact to the arm (OR = 5.0, 95% CI: 2.0–12.1, p = 0.001), and impact to the face, head, or neck (OR = 9.7, 95% CI: 1.2–77.4, p = 0.032).Significant falls were generally more associated with fall consequence than fall circumstances.Falls remain common, injurious, costly, and socially isolating events for lower limb prosthesis (LLP) users.Falls perceived as most significant by LLP users were associated with injury, reduced balance confidence, and increased fear-of-falling.Studying falls perceived by LLP users as significant may help reduce falls that matter most to LLP users.Falls remain common, injurious, costly, and socially isolating events for lower limb prosthesis (LLP) users.Falls perceived as most significant by LLP users were associated with injury, reduced balance confidence, and increased fear-of-falling.Studying falls perceived by LLP users as significant may help reduce falls that matter most to LLP users. [ABSTRACT FROM AUTHOR]

Background: Community capacity to serve people with intellectual/developmental disabilities (IDD) and behavioral health challenges is often limited. Using interdisciplinary teams to work with stakeholders, including people with IDD, their families, providers, and agencies may help increase this capacity. One example in the United States is the Support Services Teams (SST) program of a midwestern state. Specific Aims: This research aimed to identify changes before to after referral to SST in the proportion of people who used and the total number of admissions/visits, and prescriptions; and the Medicaid liability associated with emergency room (ER), hospital, and pharmacy services for SST participants. Second, the research described the SST participants and services provided. Method: The authors used Wilcoxon and McNemar's tests to compare hospital, ER, and pharmacy outcome measures for 109 people who were referred to SST and had 12 months of data before and after referral. Separate analyses were also conducted for the 88 people who remained in the community after referral and the 21 people who had short institutional stays. Findings: For the full population of SST participants, the proportion of people with a hospital admission, the total number of hospital admissions, and Medicaid liability for hospitalizations significantly decreased from before to after referral to SST. Medicaid liability for prescriptions significantly decreased for people with an institutional stay. Changes in the other outcomes trended downwards, although not significantly. Discussion: This study shows that the use of interdisciplinary teams for people with IDD and behavioral health challenges can be effective in reducing the use of services. These teams can help to build community capacity to work with these individuals and avoid more costly ER and hospital services and reduce the number of medications prescribed. [ABSTRACT FROM AUTHOR]

Individuals with intellectual disability (ID) are at risk for obesity and physical inactivity. We analyzed a subset of 2009-2010 National Core Indicators (NCI) database to examine (1) the impact of three adulthood stages- younger (20-39 years), middle (40-59 years), and older (60 years and older) on Body Mass Index (BMI) and physical activity (PA); and (2) the relationship between social-environmental context (i.e., residence type, everyday choices, and community participation) and BMI and PA, with adjustment for individual characteristics of the adults with ID. Findings highlight the need to pay more attention to obesity by providing health education and emphasizing healthy choices. Results also suggest the importance of community participation as a way of promoting more physical activity. [ABSTRACT FROM AUTHOR]

Secondary conditions are considered a direct consequence of having a disability, and many are presumed to be preventable. Although a few researchers have noted that people with disabilities are exposed to several secondary conditions, including pain, fatigue, depression, and obesity, what is lacking in the literature is a conceptual framework for understanding the antecedents, risk factors, and consequences of secondary conditions. To move the rehabilitation and public health professions toward a more unified approach to understanding and managing secondary conditions as well as distinguishing them from chronic and associated conditions, this article proposes a set of criteria for defining secondary conditions and a conceptual model that considers the potential factors associated with their onset, impact, severity, and management. [ABSTRACT FROM AUTHOR]

The impact of moving out of nursing homes into community-based settings was assessed by comparing the health, community functioning, and lifestyle satisfaction of movers and nonmovers at Time 1 and 3 years later at Time 2. We also examined whether age was a significant factor in outcomes of the transfers. The sample included 165 nonmovers and 67 movers age 30 years and older who initially were living in nursing homes. Findings indicated that movers showed benefits of improved health and community functioning. In addition, interviews with residents indicated higher increases in lifestyle satisfaction for the movers versus the nonmovers. Age of the residents did not have a significant impact on the effects of transferring out of nursing homes. [ABSTRACT FROM AUTHOR]

Many families of adults with intellectual and/or developmental disabilities in India experience difficulty in accessing services/supports, due to lack of awareness/knowledge of disability rights/laws and available services, and in accessing the services. There remains insufficient research on the information needs of these caregivers and on designing interventions that aim to increase their awareness/knowledge about human rights and supports/services. A strengths-based mixed methods needs assessment was conducted to understand the information needs of these family caregivers. Results showed that caregivers ≥50 years had significantly higher information needs than younger caregivers. Specifically, caregivers with no proficiency in English needed more information on the available services for the care recipients (n = 100). Qualitative results showed that very few caregivers had any awareness or access to information on human rights, disability-related laws/policies or available supports/services (n = 15). Study findings underscore the government's role in improving awareness-raising initiatives and imparting the information in multiple Indian languages., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Despite an increased application of social theory in assistive technology (AT) outcomes research, there continues to be a gap in integrating AT conceptual models in research design, data analysis, and results interpretation. This paper merged two preexisting AT models, the Human Activity Assistive Technology model (HAAT) and the interdependence frame for AT into a novel framework, the interdependence-HAAT model (i-HAAT). This model was used to examine the outcomes of former long-term nursing home residents using AT. The model was also used as a framework to facilitate quantitative variable identification and categorization, emphasize the interconnectivity between domain variables, and explore the infrastructural supports necessary for the successful community reintegration of deinstitutionalized AT users. Meaningful integration of theory into practice is the essential next step in generating socially responsive research that addresses AT consumer needs and moves the field forward.

Background: Obesity is associated with early mortality and chronic disease among adults with intellectual disability (ID), yet there is a paucity of effective weight management interventions for this population., Objective/hypothesis: This pilot study examined a tailored intervention on weight loss, waist circumference, A1c, and lipid profile among adults with ID., Methods: Obese adults (BMI ≥ 30 kg/m 2 ) with mild to moderate ID were randomized to an intervention (n = 17) or comparison group (n = 18) for a 24-week trial. All participants completed health-related questionnaires and clinic visits. Participants in the intervention group received access to an online weight management platform that assisted them in monitoring their diet and physical activity along with weekly coaching calls (weeks 1-12) that were tapered off to calls every other week (weeks 12-24). The comparison group completed questionnaires and clinic visits, but did not receive access to the online platform or calls. Differences in weight, waist circumference, percent body fat, A1c, lipid profile were assessed at baseline and at week 24., Results: The intervention group reduced body weight by an average of 2.7% (-2.6 kg; p = 0.02) and waist circumference by 3.4% (-3.89 cm; p = 0.02) versus the comparison. There were no statistically significant group by time interactions observed among other variables., Conclusion: Adults with ID who received the intervention were able to maintain or slightly reduce their body weight and waist circumference after the 24-week intervention. Despite not achieving the targeted sample size, the pilot study findings serve as a basis for developing accessible weight management interventions for people with ID., (Published by Elsevier Inc.)

Background: Providing care for children with disabilities can negatively influence the physical health and health behaviors of family caregivers., Objectives/hypothesis: The study purposes were to compare the prevalence of chronic conditions and health risk behaviors of family caregivers of children with and without disabilities and to examine associations between disability status of children and family caregivers' chronic conditions and health risk behaviors., Methods: This study compared chronic conditions and health risk behaviors across adult family caregivers of children with a disability (FCG-D) and family caregivers of children without a disability (FCG) living in a U.S. household using 2015 National Health Interview Survey data. Health risk behaviors were defined as heavy drinking, current smoking, physical inactivity, and unhealthy sleep. Multivariable logistic regression was conducted to compare chronic conditions and health risk behaviors between FCG-D and FCG with adjustments for demographic and healthcare coverage covariates., Results: FCG-D showed significantly greater likelihoods of chronic conditions (e.g., asthma, back pain, chronic bronchitis, heart conditions, migraine, and obesity) than FCG. FCG-D also exhibited significantly more smoking and unhealthy sleep., Conclusions: Family caregivers of children with a disability reported significantly greater likelihoods of various chronic conditions and were more likely to engage in health risk behaviors (smoking and unhealthy sleep). Further study is needed to develop intervention programs for encouraging effective health-promoting behaviors among family caregivers of children with a disability as well as health policies for decreasing health disparities experienced by this population., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: People with intellectual and developmental disabilities experience lower levels of healthy behaviors as do older persons, making health promotion a key priority for these populations., Objective: The aim of this paper is to review the two fields of developmental disability and aging health promotion research in order to understand strategies used by both and to identify emerging and innovative practices that disability researchers can learn from each other., Methods: We conducted scoping reviews of health promotion intervention peer reviewed articles in English from 1991 to 2011 for intellectual and developmental disabilities and from 2007 to 2011 for the more extensive gerontological literature. Two reviewers extracted data., Results: The disability review identified 34 studies and three main types of interventions: exercise, multi-component, and health screens. The aging review identified 176 articles which had a wider variety of intervention topics and techniques, with more articles including innovative approaches to bringing interventions to community settings across a wider variety of populations., Conclusions: As people with intellectual and developmental disabilities are living longer, disability health promotion can look to the aging literature for ideas to incorporate in future interventions for people with intellectual and developmental disabilities, while the gerontological research can learn from the research in intellectual and developmental disabilities on ways to adapt health promotion interventions to people with cognitive and physical limitations. Use of universal design principles could enable greater inclusion of people with disabilities in health promotion interventions for the general aging population., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: This pilot study examined the effectiveness of a telephone-based intervention to increase physical activity in obese African American women with mobility disabilities by targeting the removal of barriers to participation., Methods: Severely obese (mean body mass index [BMI] = 49.1 kg.m²) African American women (n = 33) with mobility disabilities completed a 6-month telephone-based physical activity coaching intervention., Results: The major environmental/facility barriers at preintervention were cost of the program (66.7%), lack of transportation (48.5%), not aware of fitness center in the area (45.5%), and lack of accessible facilities (45.5%). The major personal barriers were pain (63.6%), don't know how to exercise (45.5%), health concerns (39.4%), don't know where to exercise (39.4%), and lack of energy (36.4%). Despite only two personal barriers being significantly lower at posttest (don't know where to exercise and don't know how to exercise) (p < 0.01), total exercise time increased from < 6 minutes/day to 27 minutes/day at posttest (p < 0.001), and total physical activity time (structured exercise, leisure, indoor and outdoor household activity) increased from 26 minutes/day to 89 minutes/day at posttest (p < 0.001)., Conclusions: Interventions aimed at increasing physical activity participation among obese African American women with mobility disabilities should start with increasing their awareness/knowledge on where and how to exercise. Other reported barriers (e.g., cost, transportation, finding an accessible facility, health concerns, pain) may not be as critical to alter/remove as identifying where participants can exercise (i.e., home, outdoors, gym) and providing them with a variety of routines that can be performed safely in their desired setting.