Ageing patients with intellectual disability face many challenges in Hong Kong
A recent study by The Hong Kong Polytechnic University has identified insufficient services and accommodation, non-standardized cognitive screening and lack of intervention to delay cognitive and health deterioration as issues faced by ageing patients with intellectual disability in Hong Kong.
The systematic review of studies from 1996 to 2016 revealed a lack of health services for patients with intellectual disability in Hong Kong, an absence of clear diagnostic criteria to identify cognitive decline in these patients, and a lack of necessary intervention for such deterioration. [Hong Kong Med J 2018, DOI: 10.12809/hkmj166302]
The search of studies was restricted to articles published in English using the databases PubMed, Google Scholar and Science Direct for the keywords “intellectual disability”, “ageing”, “cognitive impairment”, “health”, and “screening”.
“This is the first study, in our knowledge, that examined the effects of ageing in patients with intellectual disability in Hong Kong and explored the issues and concerns surrounding these,” the authors noted.
A survey (n=2,159) done last year in Hong Kong showed that only 86 percent of patients with intellectual disability had access to relevant government services. [http://www.lwb.gov.hk/eng/other_info/Report%20of%20the%20Survey%20Study%20on%20Ageing%20Trend%20of%20PwIDs_c.pdf]
“There was also a discrepancy in prevalence of intellectual disability reported by the government and NGOs [67,000–80,000 vs 100,000 individuals], which suggested that a large proportion of patients are not receiving adequate support,” the authors added. [http://www.statistics.gov.hk/pub/B71501FB2015XXXXB0100.pdf.]
Furthermore, geriatric services in Hong Kong are available for individuals aged ≥60 years only, suggesting that younger patients with intellectual disability would have insufficient access to health services.
Another challenge is the lack of standardized cognitive screening instrument for individuals with intellectual disability. The Chinese version of the Dementia Screening Questionnaire for Individuals with Intellectual Disabilities (DSQIID) showed good internal consistency and excellent test-retest reliability and can be used as a screening test for intellectual disability. [Br J Psychiatry 2007;190:440-444]
Individuals who score ≥22 on the DSQIID are likely to have dementia, whereas those who score <22 are considered to have cognitive and functional decline.
“It is important to remember that DSQIID can mainly be used for screening but is not diagnostic [for cognitive decline in intellectual disability],” the authors commented.
“There are guidelines to identify cognitive decline in patients with intellectual disability. However, no clear diagnostic criteria and assessment have been defined currently. Early detection allows for therapeutic intervention before any substantial damage to cognition occurs,” they added.
Longitudinal assessment of cognition and function in patients with intellectual disability enables early detection of deterioration. It was suggested that a baseline cognitive level be established before the age of 35 years and be reviewed annually. [Psychol Med 2009;39:13-21]
Exercise was reported to be the most common intervention with a positive effect in individuals with intellectual disability. [Disabil Health J 2014;7(1 Suppl):S24-S32] Another study showed that multicomponent interventions in normal ageing adults resulted in good physical health and psychosocial outcomes. [J Policy Pract Intellect Disabil 2012;9:92-102]