Lifestyle related risk factors for poor health in residential settings for people with intellectual disabilities
Introduction
The White Paper Saving Lives: Our Healthier Nation (Department of Health, 1999) outlines four priority target areas for saving lives and improving health in the UK: cancer; coronary heart disease and stroke; accidents; and mental illness. As in the previous government document The Health of the Nation (Department of Health, 1992), Saving Lives emphasizes the need to minimize risk factors for health associated with personal lifestyles: diet; obesity; lack of physical activity; alcohol misuse; and smoking.
Studies on the health and lifestyle of people with intellectual disabilities have been limited in scope, for example covering individuals from one institution, one age group or with a specific condition. From the limited UK literature, evidence suggests some problems for people with intellectual disabilities with regard to diet, obesity and physical activity. Studies have found a high level of obesity in trainees attending a Social Education Center (Cole, 1986); high levels of undernutrition, underhydration and dehydration in a UK long stay hospital (MacDonald, McConnel, Stephen & Dunnigan, 1989); and low levels of physical activity, with the proportion of a sample of young people with intellectual disabilities taking part in sports being considerably lower than in a matched sample of young people in the general population (Flynn & Hirst, 1992).
A recent survey of 200 people with intellectual disabilities living in the community examined the presence of risk factors for health and how they related to symptoms of cardio-vascular, respiratory and psychiatric morbidity (Turner, 1997). This study found high levels of obesity in women with intellectual disabilities (30%). Levels of physical activity were found to be low, with 91% reaching the criteria for inactivity defined in The Health Survey for England 1993 (Department of Health, 1995b). This level of physical inactivity is comparable to that found in the general population in the 75 plus age group. The survey also found lower levels of smoking and drinking than in the general population. However, less dependent service users were under-represented in the survey due to low response rates from this group. As the work also suggested that risk factors may be higher in people who are less dependent, the accuracy of this information in determining general prevalence of risk factors for adults with intellectual disabilities may be questioned.
No UK studies have attempted to look in detail at the determinants of risk factors for health in people with intellectual disabilities. One factor that has been implicated is type of residential setting. A US study by Rimmer, Braddock and Fujiura (1993) found that those with severe or profound intellectual disability living with carers in the family home were much more likely to be obese than those of a comparable level of intellectual disability living in institutions. This, they suggest, is due to the accessibility of food and lack of structured physical activity in the community setting.
There is, then, inadequate information available on the prevalence of risk factors in the lives of people with intellectual disabilities and a dearth of information on the determinants of healthy lifestyles for people with intellectual disabilities. There is a need for such information to aid attempts at health promotion for this population. This study looks at the prevalence of risk factors for health in the lives of people with intellectual disabilities and also identifies variables which predict the presence of these risk factors. The data presented here were collected in the context of a larger project evaluating the quality and costs of different forms of residential provision for adults with intellectual disabilities in the UK (Emerson et al., 1999).
Section snippets
Design and sampling
The study employed a cross sectional design. We sought to collect information on selected resource and nonresource inputs, process outcomes and user outcomes for a target sample of 540 adults with intellectual disabilities. The target sample consisted of: (1) three samples of 30 adults randomly selected from the residents of three village communities; (2) five samples of 30 adults randomly selected from the residents of five residential campuses; (3) 10 samples of 30 adults randomly selected
Obesity
Information was collected on users’ weight and height. Body Mass Index (BMI) was calculated by dividing weight in kg by height in meters squared. BMI scores fall into one of four categories: underweight (BMI less than 20), normal (BMI 20 to 25), overweight (BMI 25.1 to 30) and obese (BMI greater than 30). There were no statistically significant differences between models with regard to weight either overall or, separately, for men and women. BMI information for all users combined is shown in
Discussion
With regard to the prevalence of lifestyle related risk factors for health in people with intellectual disabilities, this study shows that while the prevalence of the risk factors of smoking and alcohol abuse is considerably lower than that found in the general population, the prevalence of obesity in women and physical inactivity for both men and women is considerably higher. Comparative data for the general population using equivalent measures for diet is not available. However, the results
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