Physical performance, physical and perceived health, and the use of healthcare services in a population of adults with intellectual disability

Abstract

<p><i>Bakgrunn:</i> Voksne med utviklingshemming har dårligere fysisk og selvrapportert helse, og mindre tilgang til helsetjenester sammenlignet med generell befolkning. Dette har vært lite undersøkt i Norge. <p><i>Formål:</i> Øke kunnskap om helse og fysisk funksjon hos voksne med utviklingshemming. Undersøke faktorer assosiert med gjennomføring av fysiske funksjonstester, samt fysisk og selvopplevd helse. Identifisere udekkede behov for helsetjenester. <p><i>Metode:</i> Multisenter tverrsnittstudie med bruk av POMONA helseindikatorer. I en delstudie ble det målt kroppsmasseindex (KMI) og fysiske funksjonstester: Short physical performance battery (SPPB), timed up-and-go (TUG) test, one-legged stance test (OLS). <p><i>Resultat:</i> Delstudie: 93 deltakere, gjennomsnittsalder: 34.2 år, 58% menn. Over halvparten av deltakerne gjennomførte en eller flere målinger eller tester. Gjennomføringsrate for SPPB var 46%. Lav KMI og mer alvorlig grad av utviklingshemming predikerte manglende gjennomføring. Testskårer var betydelig under referanseverdier for generell populasjon. Lavere skårer var assosiert med høyere alder, nedsatt grovmotorisk funksjon og mer alvorlig grad av utviklingshemming. <p>Hovedstudie: 214 deltakere, gjennomsnittsalder: 36.1 år, 56% menn. Fordelingen av fysiske helsetilstander varierte med grad av utviklingshemming, 79% hadde multimorbiditet. Multivariate analyser viste signifikante assosiasjoner mellom dårlig selvrapportert helse og kvinnelig kjønn, dårligere grovmotorisk funksjon og flere fysiske helsetilstander. Et lavt fysisk aktivitetsnivå tenderte til å påvirke selvrapportert helse negativt. <p>Anbefalt årlig helsesjekk ble gjennomført hos 57%. Flere deltakere med lett utviklingshemming enn med alvorlig grad hadde gjennomført helsesjekk og vært i kontakt med fastlege. Få (13%) hadde en fungerende individuell plan. Selv om 94% rapporterte at de hadde mottatt tannlegetjenester siste året, opplevede 39% dårlig tannhelse. <p><i>Konklusjon:</i> Studien indikerte en lavere bruk av helsesjekk enn anbefalt. Fysiske funksjonstester bør inkluderes i helseundersøkelsene. Kvinner, de med redusert grovmotorisk funksjon, flere fysiske helsetilstander og lavt fysisk aktivitetsnivå har økt risiko for dårlig selvopplevd helse. Tannhelsetjenester bør forbedres. Helsefremmende strategier innen livsstilsfaktorene fysisk aktivitet og kosthold bør prioriteres for alle personer med utviklingshemming.

<p><i>Background and aim:</i> People with intellectual disabilities have poorer physical and perceived health and less healthcare services access than the general population. Health-related aspects in adults with intellectual disabilities are under-investigated. Accordingly, this study aimed to investigate factors associated with non-completion of and scores on physical performance tests, physical and perceived health, as well as access to healthcare services in Norwegian adults with intellectual disabilities. <p><i>Methods:</i> The North Health in Intellectual Disability (NOHID) study was a multicentre cross-sectional community-based study that used the POMONA-15 health indicators for data collection and some additional measures. In addition, the substudy which only involved participants from Tromsø, comprised the following physical performance tests: the Short Physical Performance Battery (SPPB), the Timed Up-and-Go (TUG) test and the One-Legged Stance (OLS) test. Body mass index (BMI) was measured. <p><i>Results:</i> In the substudy, the completion rates for one or more of the measurements or tests among 93 Tromsø participants were 57%. Approximately 45% completed the SPPB and the TUG. The participants with a mean age of 34 years showed physical performance scores comparable with participants from the general population at the age of 80 years(paper I). In the main study, data from 214 participants in five municipalities in the north and central regions of Norway showed that multimorbidity was present in 79%, with weight disorders as the most frequent health condition. Obesity was more frequent in individuals with mild intellectual disability, whereas epilepsy and constipation were significantly more prevalent in individuals with severe intellectual disability. Perceived health was reported as ‘good’ by 79% of the subjects. A perceived health rating of ‘poor’ was associated with being a woman, intellectual disability level, number of physical health conditions,and lower motor functioning. A low activity level tended to negatively impact perceived health (paper II). The use of healthcare services was relatively high, although only 57% had undergone the recommended yearly health check in the preceding year. Cancer screening for women was rarely performed. Approximately half of the participants reported receiving specialised habilitation services the preceding year and very few had a functioning individual plan. The use of physiotherapy was low. As many as 94% had been to a dentist or dental nurse the preceding year, but 32% reported not having access to a dentist or dental nurse when needed. The experienced of poor dental health was reported by 39% (paper III). <p><i>Conclusion:</i> The current study showed that despite recruitment problems it is feasible to conduct community-based health studies and physical capability tests in adults with intellectual disabilities in Norway. The study reveals a need to implement annual health checks as recommended in the national guidelines, with emphasis on individuals with more severe forms of intellectual disability. Physical performance was found to be poor among participants with intellectual disability, and tests should be part of annual health checks to monitor functional status and to guide prevention strategies. Women with intellectual disabilities, individuals with reduced motor function and those with more physical health conditions are at increased risk of lower perceived health. Also, a lack of physical activity tended to negatively influence perceived health. Therefore, more attention must be given to these individuals in terms of health-promotion efforts. The quality of dental health care should be improved; although individuals with an intellectual disability made frequent use of dental care services, they still experienced poor dental health. Health-promoting strategies involving the central lifestyle factors physical activity and nutrition should be prioritized for all adults with intellectual disabilities.