Screening for cardiovascular disease risk factors at baseline and post intervention among adults with intellectual disabilities in an urbanised Asian society
L. E. Wee
Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
Search for more papers by this authorCorresponding Author
G. C-H. Koh
Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
Correspondence: Dr Gerald Choon-Huat Koh, Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Block MD3, #03-20, 16 Medical Drive, Singapore 117597 (e-mail: [email protected]).Search for more papers by this authorL. S. Auyong
Movement for the Intellectually Disabled of Singapore, Singapore
Search for more papers by this authorA. Cheong
Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
Search for more papers by this authorT. T. Myo
Movement for the Intellectually Disabled of Singapore, Singapore
Search for more papers by this authorJ. Lin
Movement for the Intellectually Disabled of Singapore, Singapore
Search for more papers by this authorE. Lim
Movement for the Intellectually Disabled of Singapore, Singapore
Search for more papers by this authorS. Tan
Movement for the Intellectually Disabled of Singapore, Singapore
Search for more papers by this authorS. Sundaramurthy
Movement for the Intellectually Disabled of Singapore, Singapore
Search for more papers by this authorC. W. Koh
Movement for the Intellectually Disabled of Singapore, Singapore
Search for more papers by this authorP. Ramakrishnan
Movement for the Intellectually Disabled of Singapore, Singapore
Search for more papers by this authorR. Aariyapillai-Rajagopal
Movement for the Intellectually Disabled of Singapore, Singapore
Search for more papers by this authorH. Vaidynathan-Selvamuthu
Movement for the Intellectually Disabled of Singapore, Singapore
Search for more papers by this authorK. Ma-Ma
Movement for the Intellectually Disabled of Singapore, Singapore
Search for more papers by this authorL. E. Wee
Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
Search for more papers by this authorCorresponding Author
G. C-H. Koh
Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
Correspondence: Dr Gerald Choon-Huat Koh, Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Block MD3, #03-20, 16 Medical Drive, Singapore 117597 (e-mail: [email protected]).Search for more papers by this authorL. S. Auyong
Movement for the Intellectually Disabled of Singapore, Singapore
Search for more papers by this authorA. Cheong
Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
Search for more papers by this authorT. T. Myo
Movement for the Intellectually Disabled of Singapore, Singapore
Search for more papers by this authorJ. Lin
Movement for the Intellectually Disabled of Singapore, Singapore
Search for more papers by this authorE. Lim
Movement for the Intellectually Disabled of Singapore, Singapore
Search for more papers by this authorS. Tan
Movement for the Intellectually Disabled of Singapore, Singapore
Search for more papers by this authorS. Sundaramurthy
Movement for the Intellectually Disabled of Singapore, Singapore
Search for more papers by this authorC. W. Koh
Movement for the Intellectually Disabled of Singapore, Singapore
Search for more papers by this authorP. Ramakrishnan
Movement for the Intellectually Disabled of Singapore, Singapore
Search for more papers by this authorR. Aariyapillai-Rajagopal
Movement for the Intellectually Disabled of Singapore, Singapore
Search for more papers by this authorH. Vaidynathan-Selvamuthu
Movement for the Intellectually Disabled of Singapore, Singapore
Search for more papers by this authorK. Ma-Ma
Movement for the Intellectually Disabled of Singapore, Singapore
Search for more papers by this authorAbstract
Background
Adults with intellectual disabilities (ID) face significant barriers to screening participation. We determined predictors for regular cardiovascular health screening at baseline among adults with ID in Singapore, and evaluated the effectiveness of a 3-month screening intervention.
Methods
The study population involved all adults with ID aged ≥40 years receiving services from the Movement for the Intellectually Disabled of Singapore (MINDS), the largest such provider in Singapore. Over 3 months in 2011, adult clients not screened regularly at baseline for hypertension, diabetes and dyslipidaemia were offered free and convenient blood pressure, fasting blood glucose and lipid testing; data on other cardiovascular disease risk factors were also collected. Chi-square and logistic regression identified predictors of regular screening at baseline.
Results
Participation was 95.0% (227/239). At baseline, among adults with ID, 61.8% (118/191), 24.8% (52/210) and 18.2% (34/187) had gone for regular hypertension, diabetes and dyslipidaemia screening respectively; post intervention, rates rose to 96.9%, 89.5% and 88.8% respectively. Prevalence of cardiovascular disease risk factors (22.5% with hypertension, 10.6% with diabetes, 34.8% with dyslipidaemia, 10.7% obese and 90.6% lacking regular exercise) was high compared against the general population. While receiving residential services was associated with regular hypertension screening, receiving non-residential services and being independently mobile were associated with regular participation in fasting blood tests (all P < 0.05).
Conclusion
Cardiovascular disease risk factors are common among adults with ID and clinicians should proactively screen such populations. Provision of free and convenient screening for cardiovascular disease risk improved screening participation.
References
- Beange H., McElduff A. & Baker W. (1995) Medical disorders of adults with mental retardation: a population study. American Journal on Mental Retardation 99, 595–604.
- Bhaumik S., Watson J. M., Thorp C. F., Tyrer F. & McGrother C. W. (2008) Body mass index in adults with intellectual disability: distribution, associations and service implications: a population-based prevalence study. Journal of Intellectual Disability Research 52, 287–298.
- Bigby C. (2008) Beset by obstacles: a review of Australian policy development to support ageing in place for people with intellectual disability. Journal of Intellectual and Developmental Disability 33, 76–86.
- Bigby C., Webber R., Bowers B. & McKenzie-Green B. (2008) A survey of people with intellectual disabilities living in residential aged care facilities in Victoria. Journal of Intellectual Disability Research 52, 404–414.
- Braunschweig C. L., Gomez S., Sheean P., Tomey K. M., Rimmer J. & Heller T. (2004) Nutritional status and risk factors for chronic disease in urban-dwelling adults with Down syndrome. American Journal on Mental Retardation 109, 186–193.
- De Winter C. F., Magilsen K. W., van Alfen J. C., Penning C. & Evenhuis H. M. (2009) Prevalence of cardiovascular risk factors in older people with intellectual disability. American Journal on Intellectual and Developmental Disabilities 114, 427–436.
- Hand J. E. & Reid P. M. (1996) Older adults with lifelong intellectual handicap in New Zealand: prevalence, disabilities and implications for regional health authorities. New Zealand Medical Journal 109, 118–121.
- Health Promotion Board (2005) Health Promotion Board, Government of Singapore. Available at: http://www.hpb.gov.sg/hpb/default.asp?TEMPORARY_DOCUMENT=1769&TEMPORARY_TEMPLATE=2 (retrieved 15 December 2012).
- Health Promotion Board (2011) Health Promotion Board, Government of Singapore. Available at: http://www.hpb.gov.sg/programmes/article.aspx?id=3672 (retrieved 15 December 2012).
- Janicki M. P., Davidson P. W., Henderson C. M., McCallion P., Taets J. D., Force L. T. et al. (2002) Health characteristics and health services utilization in older adults with intellectual disability living in community residences. Journal of Intellectual Disability Research 46, 287–298.
- Jeevanandam L. (2009) Perspectives of intellectual disability in Asia: epidemiology, policy, and services for children and adults. Current Opinion in Psychiatry 22, 462–468.
- Kapell D., Nightingale B., Rodriguez A., Lee J. H., Zigman W. B. & Schupf N. (1998) Prevalence of chronic medical conditions in adults with mental retardation: comparison with the general population. Mental Retardation 36, 269–279.
- Lewis M. A., Lewis C. E., Leake B., King B. H. & Lindemann R. (2002) The quality of health care for adults with developmental disabilities. Public Health Reports 117, 174–184.
- Lin J. D., Wu C. L., Lin P. Y., Lin L. P. & Chu C. M. (2011) Early onset ageing and service preparation in people with intellectual disabilities: institutional managers' perspective. Research in Developmental Disabilities 32, 188–193.
- Lin L. P., Lin J. D., Sung C. L., Liu T. W., Liu Y. L., Chen L. M. et al. (2010a) Papanicolaou smear screening of women with intellectual disabilities: a cross-sectional survey in Taiwan. Research in Developmental Disabilities 31, 403–409.
- Lin P. Y., Lin L. P. & Lin J. D. (2010b) Hypertension, hyperglycemia, and hyperlipemia among adolescents with intellectual disabilities. Research in Developmental Disabilities 31, 545–550.
- Mikulovic J., Marcellini A., Compte R., Duchateau G., Vanhelst J., Fardy P. S. et al. (2011) Prevalence of overweight in adolescents with intellectual deficiency. Differences in socio-educative context, physical activity and dietary habits. Appetite 56, 403–407.
- Ministry of Health (2012) Ministry of Health, Government of Singapore. Available at: http://www.moh.gov.sg/content/moh_web/home/pressRoom/pressRoomItemRelease/2012/more_singaporeanstobenefitfromsubsidizedgpcarefromtoday.html (retrieved 15 December 2012).
- Ministry of Health, Singapore (2003) Health Screening: Clinical Practice Guidelines. Government of Singapore, Singapore.
- Ministry of Health, Singapore (2005) National Health Survey 2004. Government of Singapore, Singapore.
- Ministry of Health, Singapore (2009) National Health Surveillance Survey 2007. Government of Singapore, Singapore.
- Ministry of Health, Singapore (2011a) National Health Survey 2010. Government of Singapore, Singapore.
- Ministry of Health, Singapore (2011b) Screening for Cardiovascular Disease and Risk Factors: Clinical Practice Guidelines. Government of Singapore, Singapore.
- Moss S. J. (2009) Changes in coronary heart disease risk profile of adults with intellectual disabilities following a physical activity intervention. Journal of Intellectual Disability Research 53, 735–744.
- Movement for the Intellectually Disabled of Singapore (2011) Movement for the Intellectually Disabled of Singapore. Available at: http://www.minds.org.sg/AdultSvcs.html (retrieved 15 December 2012).
- Patja K., Mölsä P. & Iivanainen M. (2001) Cause-specific mortality of people with intellectual disability in a population-based, 35-year follow-up study. Journal of Intellectual Disability Research 45, 30–40.
- Phua H. P., Chua A. V., Ma S., Heng D. & Chew S. K. (2009) Singapore's burden of disease and injury 2004. Singapore Medical Journal 50, 468–478.
-
Scheepers M., Kerr M., O'Hara D., Bainbridge D., Cooper S. A. & Davis R. (2005) Reducing health disparity in people with intellectual disabilities. Journal of Policy and Practice in Intellectual Disabilities 2, 249–255.
10.1111/j.1741-1130.2005.00037.x Google Scholar
- Sohler N., Lubetkin E., Levy J., Soghomonian C. & Rimmerman A. (2009) Factors associated with obesity and coronary heart disease in people with intellectual disabilities. Social Work in Health Care 48, 76–89.
- Spadea T., Bellini S., Kunst A., Stirbu I. & Costa G. (2010) The impact of interventions to improve attendance in female cancer screening among lower socioeconomic groups: a review. Preventive Medicine 50, 159–164.
- Sullivan S. G., Glasson E. J., Hussain R., Petterson B. A., Slack-Smith L. M., Montgomery P. D. et al. (2003) Breast cancer and the uptake of mammography screening services by women with intellectual disabilities. Preventive Medicine 37, 507–512.
- Truesdale-Kennedy M., Taggart L. & McIlfatrick S. (2011) Breast cancer knowledge among women with intellectual disabilities and their experiences of receiving breast mammography. Journal of Advanced Nursing 67, 1294–1304.
- Tyrer F. & McGrother C. (2009) Cause-specific mortality and death certificate reporting in adults with moderate to profound intellectual disability. Journal of Intellectual Disability Research 53, 898–904.
- Wallace R. (2001) Biopsychosocial profile of adults with ID. Medical Journal of Australia 174, 200–201.
- Wallace R. A. & Schluter P. (2008) Audit of cardiovascular disease risk factors among supported adults with intellectual disability attending an ageing clinic. Journal of Intellectual and Developmental Disability 33, 48–58.
- Ward R. L., Nichols A. D. & Freedman R. I. (2010) Uncovering health care inequalities among adults with intellectual and developmental disabilities. Health & Social Work 35, 280–290.
- Wee L. E. & Koh G. C. (2011) The effect of neighborhood, socioeconomic status and a community-based program on multi-disease health screening in an Asian population: a controlled intervention study. Preventive Medicine 53, 64–69.
-
Wee L. E., Koh G. C. H., Yeo W. X., Chin R. T., Wong J. & Seow B. (2012) Screening for cardiovascular disease risk factors in an urban low-income setting at baseline and post-intervention: a prospective intervention study. European Journal of Preventive Cardiology doi: 10.1177/2047487311433890.
10.1177/2047487311433890 Google Scholar
- Westerinen H., Kaski M., Virta L., Almqvist F. & Iivanainen M. (2007) Prevalence of intellectual disability: a comprehensive study based on national registers. Journal of Intellectual Disability Research 51, 715–725.
- Wilkinson J. E., Deis C. E., Bowen D. J. & Bokhour B. G. (2011) ‘It's easier said than done’: perspectives on mammography from women with intellectual disabilities. Annals of Family Medicine 9, 142–147.
- Wu Y., Tai E. S., Heng D., Tan C. E., Low L. P. & Lee J. (2009) Risk factors associated with hypertension awareness, treatment, and control in a multi-ethnic Asian population. Journal of Hypertension 27, 190–197.
