1. Meeting the Needs of Aging Persons with Developmental Disabilities Cross Network Collaboration for Florida Aging in Individuals with a Developmental Disability
Module 3
Based on ADRC training developed by:
Kathleen M. Bishop, Ph.D., and Ron Lucchino, Ph.D.
ADRC Training

2. Purpose of Module 3 Understand aging as a normal process
Dispel myths about aging and developmental disabilities
Recognize how aging may increase risk factors for disease
Note – The summary emphasizes that all individuals experience the same influences
as they age
ADRC Training

3. Purpose of Module 3
Understand aging with developmental disabilities is the overlap of aging and disabilities
Recognize how medications may affect adults with developmental disabilities
Note – The objective is to increase the understanding of aging changes by the ADRC to better determine appropriate services for the caregiver and adult child with developmental disabilities
ADRC Training

4. Meeting the Needs of Aging Persons with Developmental Disabilities Cross Network Collaboration for Florida What Is Aging?
ADRC Training

5. Aging Factors Determined by interaction of three factors
Life-long choices (diet, physical and mental exercise, self-esteem)
Environment (physical, cultural and social)
Genetics
Successful aging from positive genes
Negative aging from life-long or late-onset gene
1. Emphasize that the interaction of lifestyle, environment and
genetics influence individual aging changes
2. Individuals can choose lifestyle and environment
3. Successful aging is considered “normal” aging
ADRC Training
ADRC Training 5

6. Aging Changes Age related: Common to everyone
Interventions may slow decline
Age associated: Not common to everyone
Associated with disease, disorders, poor lifestyle choices, negative environment
Controlled by individual choices
Common means everyone will experience the same aging changes
ADRC Training

7. Aging in Adults with Developmental Disabilities
Interaction of pre-existing disability with factors of aging may result in:
Increased risk factors with earlier onset of symptoms
Increased risk for inappropriate medical treatment
Increased vulnerability to a more restrictive environment
Emphasize that adults with DD also experience common aging changes – but
overlapping disabilities may modified how they are expressed
ADRC Training

8. Aging in Adults with Developmental Disabilities
Interaction of pre-existing disability with factors of aging may result in:
Increased challenging behaviors due to communication difficulties
Increased cost for treatment and interventions
Increased staff/family frustration due to lack of communication and knowledge
The key point is that services may be inappropriate due to mimicking or masking of diseases with overlapping changes
ADRC Training

9. Meeting the Needs of Aging Persons with Developmental Disabilities Cross Network Collaboration for Florida Myths About Aging and Developmental Disability
ADRC Training

10. Myths - Aging and Developmental Disability
All individuals with developmental disabilities experience earlier onset of aging - False
All adults with Down syndrome will exhibit the symptoms of Alzheimer’s disease - False
Majority of adults with developmental disabilities live in supervised residential care facilities - False
Emphasize these myths are common false perceptions about adults with DD
ADRC Training

11. Consequences of Myths Affect quality of assessment and intervention
Influence attitudes of staff, family, and providers
Limit available choices and resources
Affect quality of life
Emphasize myths may result in inappropriate or no services
ADRC Training

12. Myth 1 – Early Onset of Aging
Persons with mild to moderate developmental disabilities and the general adult population experience:
Same rate and age-related changes
Similar longevity
Individual aging influenced by genetics and lifestyle choices
The main point is even though aging is an individual process everyone experiences the same aging changes and rate of change
ADRC Training

13. Myth 1 – Early Onset of Aging (Continued)
The older adult with Down syndrome or cerebral palsy also experiences:
Same aging changes but earlier onset
Same rate of change but compressed due to shorter longevity
Emphasize the adult with Down syndrome or cerebral palsy experience the same rate and changes of aging - but earlier
ADRC Training

14. Aging Curve Maximum vitality 100 vitality vitality % vitality 30 age
General aging curve
vitality
vitality
% vitality
Aging DD curve
1.      The three lines in the graph illustrate the same changes and rates in the general population and the developmental disabilities population but earlier for Down syndrome and cerebral palsy adults
2.      The DD and the DS and CP lines have reduced vitality due to the overlay of disabilities
Vitality describes the level of biological functioning – 100% is maximum functioning
minimum
vitality
Down syndrome and Cerebral Palsy
death 30
birth
age
conception
ADRC Training

15. Myth 2 – Down Syndrome and Alzheimer’s Disease
1.      Emphasize that Down syndrome adults have early onset of Alzheimer’s
disease - 70% by age 70
2. Emphasize that only 70% of adults will be diagnosed with Alzheimer’s disease - 30% will not be
Janicki, M.P. & Dalton, A.J.  (2000).  Prevalence of dementia and impact on intellectual disability services.  Mental Retardation,38, 277‑289.
ADRC Training

16. Myth 3 – Living Situation
10 %
Note that the majority of DD adults are living with caregivers
Full citation: Braddock, D., Felce, D., Emerson, E. & Stancliffe, R.J. (2001). Living circumstances of children and adults with mental retardation or developmental disabilities in the United States, Canada, England and Wales, and Australia. Mental Retardation and Developmental Disabilities Research Reviews, 7,
90%
Braddock, D., Felce, D., Emerson, E. & Stancliffe, R.J. (2001). Mental Retardation and Developmental Disabilities Research Reviews, 7,
ADRC Training

17. Meeting the Needs of Aging Persons with Developmental Disabilities Cross Network Collaboration for Florida Aging in Individuals with a Developmental Disability
Emphasize that the next set of slides illustrate that adults with developmental disabilities experience the same aging as the general population
ADRC Training

18. Differentiate “Normal” Aging Changes from Disease
Determine types of interventions to best meet needs
Determine appropriate services
Develop activities appropriate for age- related cognitive/physical changes
Maintain quality of health through increased awareness of changes
The key point is no diseases are part of the aging process – diseases are the result of poor lifestyle or negative genes
ADRC Training

19. Pre-existing Developmental Disability Aging Effects
Likelihood of “diagnostic over-shadowing”
Changes related to the disability result in inappropriate or no interventions
Pre-existing cognitive challenges assumed to be symptoms of dementia
Pre-existing disability may be misdiagnosed as disease
1.      Over-shadowing means overlay of the disabilities influences aging
2.      Call attention to the decline in vitality in slide 16 due to over-shadowing or overlaying
ADRC Training

20. Risk from Inappropriate Intervention
Reduced vitality and quality of life
Modified aging process
Increased misdiagnosis for other diseases (especially Alzheimer’s disease)
Increased behavioral changes
Note that if over-shadowing is not taken into account there may be risk of inappropriate services
ADRC Training

21. Meeting the Needs of Aging Persons with Developmental Disabilities Cross Network Collaboration for Florida Age-Related Changes Everyone Experiences
Mention that the next set of slides describe aging changes experienced by everyone
ADRC Training

22. Sensory Changes Affect the Older Adult
Reduced sensory acuity
Increased masking of sensory impairments
Reduced potential for quality of life and independence
Increased social isolation
Emphasize the next 3 slides describe reduced hearing and vision
ADRC Training

23. How Is Hearing Affected by Aging?
Increased loss of high frequency sounds (children and females voices in particular)
Increased interference with hearing
Background sounds interfere with communication
Increased tinnitus – ringing in the ears
Emphasize the next 3 slides describe reduced hearing and vision
ADRC Training

24. How is Vision Affected by Aging?
Increased glare (light reflection) sensitivity
Increased difficulty adjusting to reduced lighting
Increased difficulty with busy visual patterns
Emphasize the next 3 slides describe reduced hearing and vision
ADRC Training

25. Effects of Hearing and Visual Impairments on Older People
Increased risk of falls
Decreased social interaction
Increased inappropriate behavior
Decreased verbal communication
Increased misdiagnosis of dementia
Emphasize that the reduction in senses may be miss-diagnosed as a disease
ADRC Training

26. Other Age-related Changes in Older People
Reduced muscle mass by 15%
Increased risk of falls
Decreased ability for physical activities
Decreased thyroid function
Decreased body temperature
Increased symptoms of acute dementia
1.      Emphasize muscle loss is normal, but lack of exercise can result in greater loss - increasing risk for falls
2.      Important to emphasize that although slowing of the thyroid is normal it can be miss-diagnosed as dementia
ADRC Training

27. Other Age-related Changes in Older People
Reproductive system (male)
Enlarged prostate - reduced flow of urine and reduced ability to urinate
Reproductive system (female)
Decreased estrogen - menopause
Increased bone loss
Increased risk of depression
Increased risk of heart disease
Increased short-term memory impairment
1.      The key point is male adults with developmental disabilities may have enlarged prostate glands that interfere with urinating
2.      Point out that they may not complain of reduced ability to urinate due to communication problems - may result in behavior problems
ADRC Training

28. Lesser Age-related Changes in Older People
IQ remains the same or increases
Personality remains the same
Ability to learn new skills remains the same
Long-term memory remains the same
Little change in memory recall
The key point is many functions of the nervous system are not affected by aging – noticeable changes may be a sign of a problem
ADRC Training

29. Meeting the Needs of Aging Persons with Developmental Disabilities Cross Network Collaboration for Florida Early Aging Changes Experienced by Adults with Down Syndrome and Cerebral Palsy
Point out that the next section describes early aging changes that are experienced later by the general population
ADRC Training

30. Early Aging Down Syndrome and Cerebral Palsy Risk Factors
Increased early symptoms
Increased severity of symptoms
Increased symptoms may be:
Overlooked
Assumed to be “normal” aging
Misdiagnosed as dementia
Note: An individual with Down syndrome must also have a diagnosis of retardation to be eligible for APD services.
Note that Down syndrome adults can receive services if they have accompanying diagnosis of retardation
ADRC Training

31. Early Aging in Down Syndrome Adults
Shorter longevity
Reduced cognitive and physical function
Increased behavioral problems
Changes may mimic or mask diseases or disorders
Remind audience of DS adult line in slide 15 – early symptoms and fast decline
ADRC Training

32. Early Aging in Down Syndrome Adults
Slowing of the thyroid (hypothyroidism) increases risk for:
Increased feelings of cold, tiredness, lethargy
Decreased appetite
Increased need for sleep
Increased short-term memory impairment
Increased confusion
Note – hypothyroidism is a major problem in Down syndrome
adults and is often overlooked
ADRC Training

33. Early Age-related Changes in Cerebral Palsy Adults
Decreased muscle strength after many years of no change
Increased risk for urinary tract infections and incontinence
Increased difficulty in swallowing
Reduced stamina
Increased fatigue
Note - muscle loss in adults with cerebral palsy is very noticeable
ADRC Training

34. Meeting the Needs of Aging Persons with Developmental Disabilities Cross Network Collaboration for Florida Adverse Drug Reaction Risk Factors in Adults with Developmental Disabilities
Note - summarize this section by noting very little is know about medications and developmental disabilities
ADRC Training

35. Medication Risk Factors in Older Adults
Increased levels of medications in the blood for longer times
Increased use of multiple medications
Little understanding of medication interaction
Increased adverse drug reactions (ADRs) masking or mimicking dementia
Note - in all older adults there is an increased risk for adverse drug reactions – unwanted response to medication
ADRC Training

36. Medication Risk Factors in Older Adults
Increased dosages of medications
Few studies of medication use in older adults with developmental disabilities
Few health care providers trained to identify adverse effects of medications
Note - health care practitioners are not prepared to recognized adverse drug reactions in adults with developmental disabilities - often attribute them to diseases
ADRC Training

37. Additional Risk Factors Affecting Drug Reactions in Older Adults
Population variations due to gender, race, ethnicity
Increased side effects from anti-depressants Prozac & Paxil are twice that in Caucasions than in Hispanics
Increased Tardive Dyskinesia from anti- psychotic drugs in African-Americans
Increased response to anti-psychotic drugs by Asians
Little knowledge of how medications affect females
Note – in addition to aging, gender, ethnicity and race also influence medications in all individuals
ADRC Training

38. Additional Risk Factors Affecting Drug Reactions in Older Adults
Individual variations in response
Age-related differences
Disability specific variations in response
Older adults with developmental disabilities will “age into” medications with long-term use
Note - the concept of “aging into” medications means that long term use of medication may begin to have adverse drug reactions with aging when there was no prior evidence of reactions
ADRC Training

39. Adverse Drug Reactions Affect Body Function
Examples of biological changes
Increased/decreased blood pressure
Increased urine retention or incontinence
Examples of behavioral changes
Increased risk for depression
Increased risk for paranoia
Note - adverse drug reactions are listed in four categories –
biological and behavior changes are two of the four –
see Manual Module 3 for additional information
ADRC Training

40. Adverse Drug Reactions Affect Body Function
Examples of neurological changes
Increased change in sleep patterns
Increased risk for seizures
Examples of decline in muscle coordination
Increased risk for muscle tremors
Decreased coordinated muscle movement
Note- neurological and muscle coordination are the other two –
see Manual Module 3 for additional information
ADRC Training

41. Adverse Drug Reactions That Mimic Dementia
Increased agitation
Increased anxiety
Increased behavioral changes
Increased decline in cognitive functioning
It is important to emphasize that adverse drug reactions mimic or mask
diseases, including dementia.
ADRC Training

42. Adverse Drug Reactions That Mimic Dementia
Decreased communication skills
Increased disorientation to person, place or time
Increased loss of interest in normal activities
Note- emphasize that many adverse drug reactions may not be recognized by the health care profession resulting in miss-diagnoses and inappropriate services
ADRC Training

43. Adverse Drug Reactions That Mimic Dementia
Increased risk for confusion
Increased risk for delusions
Increased risk for depression, sadness
Increased risk for unexplained excitability
Increased risk for restlessness, wandering
Note- emphasize that these changes may be either adverse drug reactions, dementia or both
ADRC Training

44. Summary of Module 3 Myths may affect how services are applied
Aging is experienced by everyone
Aging is an individual process
Influenced by genetics and lifestyle
Disabilities over-lay influences on aging
Summarize Module 3 by noting:
1. There are myths that interfere with the types of services
2. Aging is experienced by everyone
ADRC Training

45. Summary of Module 3
Increased risk of mimicking or masking diseases or disorders from early aging in adults with Down syndrome and cerebral palsy
Increased risk for adverse drug reactions that mimic or mask diseases
Summarize Module 3 by noting:
1. An increased risk of misdiagnosis of dementia in Down syndrome
2. Medications may mimic or mask diseases and disorders
ADRC Training

46. Group Discussion
Questions
ADRC Training