Nursing older people with intellectual disabilities

People with intellectual disabilities are among the most disadvantaged in our societies and communities. This population experience greater levels of ill health and significant difficulties accessing health care. While some countries still segregate people into institutional care settings most now are working toward community inclusion. However, in either circumstance it can be expected that this group will experience social exclusion and abuse, which incurs a further set of associated health and wellbeing issues. These disadvantages, inequalities and disparities can be measured in health outcomes, with people with intellectual disabilities having a significantly reduced life expectancy and more likely to die avoidable deaths.

The life expectancy of people with intellectual disabilities is twenty years less than the general population, so it could be assumed that the health conditions and issues associated with older age could start appearing at a significantly younger age than the general population. While this chapter will consider both the age related and disability associated health needs, it will also reflect on determinants of health across the lifespan, as these allow us a perspective on the causes and resolutions to some of these challenges. It provides learning challenges to the reader to help to deepen understanding and knowledge.

The care and support that people experience is influenced by how their strengths and needs are defined and viewed. Therefore, the chapter starts by outlining how intellectual disability is defined across the world and the prevailing perspectives on this population and society. These perspectives have an impact into how this population are cared and supported where and by whom in different countries across the world, which are considered as wider influences on the health status.

The chapter provides a contemporary outline as to the increased physical and mental health conditions that people with intellectual disabilities experience and the greater likelihood of multimorbidity presents unique challenges to specialist healthcare systems.

Disparities in healthcare can also be seen in end-of-life care and how people with intellectual disabilities experience death of family and friends.

To help resolve some of these issues a simple framework is presented. This tool is intended to enable nurses working with older adults with intellectual disabilities to make accommodations and deliver good quality care.

Throughout the chapter, case studies and learning activities are presented to provide the reader with an opportunity to reflect on their personal and professional experiences of people with intellectual disabilities and consider how this care and support could be improved. Finally, some additional resources are shared for further consideration.