Biomedical subjects
Publications and source records attributed to M J Haveman.
In a GP database, 318 people with intellectual disability (ID) appeared to have 2.5 times more health problems than people without ID. This short report deals with the nature of the health problems. Consequences for health care policy are discussed.
The objective of this study was to determine the prevalence and incidence of the most frequent chronic health problems in relation to age in people with intellectual disabilities living in residential facilities in the Netherlands. A prospective cohort study was done with four data collections, each with an interval of one year. Data were collected by means of questionnaires which were completed by each person's physician. Striking results included the reported high prevalence and incidence of visual and hearing impairment, which was even more pronounced in people with Down's syndrome than in people with intellectual disability resulting from other causes. Gastrointestinal problems also appeared to have high incidence rates. Dementia was frequently reported in people with Down's syndrome aged 40 years and older. The results reflect the need for a more predictive policy which can anticipate health problems in people with intellectual disability.
In a general practice database containing data on 62,000 patients, those with intellectual disability (ID) were traced. Health problems in this database were recorded according to the International Classification of Health Problems in Primary Care (ICPC) code. By using selected codes, 318 people with ID (0.65% of the study population) were found; the sample contained nearly as many false positives. Adding up the percentage of people with ID living in residential facilities, the total prevalence of people with ID was estimated as 0.82%. Documentation on the cause and level of ID was available in about half of the cases. The demographic characteristics of the people with ID were significantly different from the general population: there was a higher percentage of males and a lower percentage of people over 50 years of age among those with ID. Information about the use of home care was virtually non-existent in the general practice data. The results are compared with those of other studies. The discussion deals with reasons for complete documentation of cases with ID in general practice and the role of the general practitioner in health care supply to people with ID.
Determinants of (1) referral to psychiatric services and (2) the amount of mental health care consumed were analysed in a population of individuals with intellectual disability, using data from a cumulative mental health case register in a defined geographical area. Associations between level of disability, gender, age and social environment on the one hand, and psychiatric referral and service consumption on the other were expressed as odds ratios (ORs). Being older (OR = 1.9; 95% CI = 1.5-2.5), having milder intellectual disability (OR = 1.4; 95% CI = 0.9-2.3) and living alone (OR = 5.8; 95% CI = 2.8-11.9) predicted a higher probability of receiving psychiatric treatment. Living alone (OR = 15.3; 95% CI = 1.7-136.1) was also associated with higher level of mental health service consumption.
Mortality and avoidable death was studied in a cohort of 1168 people with severe self-injurious behaviour (SIB) in the Netherlands. Fifty-seven people died over a 5-year period (1990-1995). The observed mortality in the cohort studied was higher than the expected mortality. The age-specific mortality was highest in the 30-39-year-old age-group. Diseases of the respiratory system were found to be the most prevalent cause of death, followed by diseases of the nervous system and sensory organs. In six people (12%), the general practitioner and staff member considered SIB to be related to death. The causes of death were thought to be avoidable in two cases. The results are discussed in terms of data collection and avoidability of death.
From 1990 to 1993, the University of Limburg and the Pepijn Centre, the Netherlands, have performed a prospective cohort study on ageing and intellectual disability. The key questions of the study were: "To what degree do the level of care dependence and activities of daily living (ADL) differ between age groups, and to what degree do these skills change during the study period (3 years)? Are the changes age related?'. Looking at the changes in time, the results show that the level of care dependence did not change substantially in the sample of 1602 residents of Dutch facilities for people with intellectual disability. Only the oldest residents (70+ years) showed a significant decline in independence. The results also show that the skills of young people with Down's syndrome (< 40 years) did not change substantially, whereas older people with Down's syndrome (40+ years) showed a substantial decrease in ADL-skills. The ADL-skills of the residents with other aetiological diagnoses younger than 60 years of age did not change substantially, while the older residents (60-69 and 70+ years) showed a significant decrease in ADL-functions. The trend between changes in ADL and age in both aetiological groups was statistically significant. Attention is paid to the implications of these findings in the discussion.
The aims of this study were to review what is currently known about comorbidity in people with Down's syndrome and to determine if their relative risk for certain disorders was increased. Analysis was carried out on the published literature from 1982 through 1994. In order to be included in this study, articles had to meet predetermined criteria. The strengths and weaknesses of the selected articles were considered in this review. The estimation of relative risks was done by calculating the odds ratio (OR). Odds ratios of > 2 or < 0.5 were found in more than one article for congenital heart defects, hypothyroidism, hearing impairment and hepatitis B. Only one article indicated an OR within this range for all of the following disorders: obesity, epilepsy, degenerative spine disorders and a wide atlanto-axial distance. The results were unclear in the areas of hyperthyroidism, visual disorders, dementia and psychiatric disorders. The concept of comorbidity, i.e. establishing the relationships between the various conditions in one person and understanding the implications for medical care, seems promising, especially for people with intellectual disability. Further work in this area may well improve the quality of care offered to these people.
OBJECTIVE: Description of use of medication by people with mental handicaps in relation to age, level of mental handicap and living facility. DESIGN: Cross-sectional study. SETTING: Institutions and group homes for people with mental handicaps in North Brabant and Limburg, the Netherlands. METHODS: Of a patient sample (n = 1265), stratified according to age and living facility (i.e. institution or group home) data were collected by means of questionnaires to be completed by the general practitioners. For 101 persons data about level of mental handicap were lacking. RESULTS: 57% of the patients used one or more drugs. The numbers of drugs used were significantly related to (increased) age and level of mental handicap. Older patients more often used antipsychotics, laxatives and cardiovascular medication, younger ones more often used anticonvulsants. More severely handicapped persons used antipsychotics, anticonvulsants, laxatives, antacids, psychoactive medication and gastrointestinal medication more often. There was no relationship between amount of medication and living facility. CONCLUSION: Many mentally handicapped use medication. Since epilepsy, psychiatric and behavioural diseases and gastrointestinal problems are frequent, and because the patients offer little spontaneous information, alertness with respect to drug interaction and side effects is indicated.
For policy purposes as well as for the provision of individual care, it is relevant to known which individual characteristics have impact upon the level of care dependence. For purposes of individual care provision, characteristics which can be influenced and which also have an important impact upon the care dependence are of interest. This study showed that the profoundly mentally handicapped are almost all totally dependent upon care, and therefore additional information about individual characteristics is superfluous. The results of logistic regression analyses showed a statistically significant and important impact of ADL-functions. Exactly which other characteristics are relevant to consider depends upon the level of care dependence and the level of mental handicap.
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Within the framework of a study on the ageing process of people with mental handicap in the Netherlands, information about visual and hearing impairments in 1583 people with mental handicap living in group homes or institutions was obtained from their physicians by means of a written questionnaire. Of the people with Down's syndrome (DS) who were older than 50 years of age, 46% had a visual impairment, whereas approximately 13% of subjects with other causes of mental handicap at the same age experienced similar visual impairment. Hearing loss in this age group was reported in 28% of people with DS, but only in 8% of subjects with other causes of mental handicap. The most common eye condition was cataracts, and the most frequent cause of hearing impairment was infection. In people with severe and profound mental handicap of all ages, sensory impairments were more frequent than in persons with mild or moderate mental handicap. Glasses or hearing aids were rarely used by people with severe or profound mental handicap. Assessment of visual and hearing impairments in people with mental handicap seemed clearly indicated, especially in those aged 50 years and older, in those with DS, and in those with severe or profound mental handicap.
For policy purposes as well as for the provision of individual care, it is relevant to know which individual characteristics have an impact upon the level of care dependence. For policy purposes, it is preferable to predict the level of care dependence as efficiently as possible. This study of residents of institutions and group homes for people with mental handicap showed that profoundly mentally handicapped residents are almost all totally dependent upon care: additional information about the individual characteristics of this group is superfluous. The results of logistic regression analyses for residents with severe or mild mental handicap showed that age, gender and aetiological diagnosis (Down's syndrome or other) do not have significant predictive power. For the level of care dependence, adding the score on Activities of Daily Life (ADL) to the various models improved the predictive power. It depends on the level of mental handicap and on the level of care dependence which one wants to predict which other individual characteristics have to be included in order to improve predictive power.
This article reports on age-specific findings of mental health problems among residents with Down's syndrome (DS) (n = 307) and without (non-DS) (n = 1274 in dutch group homes and institutes for people with mental retardation. Whereas a proportional increase of psychological problems was found for elderly DS persons with severe mental retardation, non-DS residents did not show such age-specific differences. High ratings of psychological problems for the elderly DS residents corresponded very well with the diagnosis of 'dementia' made by the physicians. Only for non-DS persons with severe mental retardation was a proportional decrease of challenging behaviour found with advanced age. Whereas psychological problems in elderly DS persons could be explained for the greater part of the diagnosis 'dementia', challenging behaviour--although also common in elderly DS--was shown to be a more independent phenomenon. With regard to psychiatric diagnosis, non-DS residents with mild retardation had six times as much a mental disorder, and non-DS residents with severe or profound mental retardation had up to 15 times as much, compared with their DS peers.
In 1988 a study aiming to evaluate the effectiveness of an outpatient geriatric clinic was started. Elderly persons (75-90 years) living at home or in the two old people's homes in the municipality Sittard (The Netherlands) were screened on physical vulnerability by means of oral interviews. It was possible to collect data about demographic variables and depressive complaints of 222 frail elderly. For this article the internal consistency of the Zung-depression scale (DSI) was tested for the study group. Relations between depression and the registered demographic variables are discussed. It showed that Cronbach's alpha of the depression scale is .82. A varimax rotated factor analysis resulted in six factors with a high percentage of explained variance on the first factor. This result indicates that the instrument is unidimensional. There was no systematic bias introduced by physical vulnerability. Of all frail elderly, 28% had depressive complaints. In general, women scored somewhat higher on the depression index than men. Only a slight relation between depression and age was found. Concerning household composition this study showed that frail elderly living alone and residents of old people's homes had significantly more depressive complaints than frail elderly living with others and independently living frail elderly respectively.
In the period 1986-1988, a cross-sectional study was carried out in 21 mental deficiency institutions in two provinces of the Netherlands. One of the key-questions of this study was whether there are differences between the younger and older adult mentally handicapped in Dutch mental deficiency institutions, in prevalences of diseases and sensory handicaps, mobility, motor skills and social functioning. In this article, some results of the study are presented.
Since the 1920s psychiatric foster care has been considered as an important alternative to psychiatric hospitalization in the Netherlands. About one percent of the mental hospital patients are actually living with contracted families. These patients have their meals with their foster families, and stay there at night and at the weekends. Foster families can obtain support from hospital staff. Day-programmes, treatment and work rehabilitation, however, are usually undertaken in the grounds of the mental hospital. Some data will be presented on the characteristics, skills, social integration and consumer satisfaction of all 188 patients staying with 162 foster families. A comparison is made with a random-sample of hospital inpatients (N = 381), patients in sheltered homes (N = 179) and in day-centres (N = 86).
The main aim of this study was to find a cut-off point in the age-distribution at which the physical fragility of the severe mentally handicapped residents increases. The following criteria for age-related fragility were used: mortality risk, morbidity rates of chronic diseases, motor problems and social functioning. The age-specific mortality risks were computed by means of data of the National Case register in the period 1978-1983. The morbidity-rates, rates of motor handicaps and handicaps of social functioning were calculated from a random sample of 550 severe mentally handicapped in 100 institutions and sheltered homes. The results of this cross-sectional study showed a high prevalence of diseases and handicaps, and a high mortality-rate until the age of 30, mainly determined by pre- and perinatal birth defects. The most healthy residents were found according to our criteria in the 30-50 year age group. A significant increase in health problems of 'the elderly' were observed only after the age of about 50 years, as indicated by a high prevalence of diseases and sensory handicaps, mortality risk, motor problems and problems with basis personal skills. The linguistic skills of elderly persons were significantly better in comparison with the younger residents.
How many longstay patients could be equally served by less sheltered facilities, and what are the main reasons for staff members to judge patients suitable for such alternative care? These were two questions in a Dutch study (1984-1985) of five mental hospitals. The attending psychiatrists in these hospitals and members of the nursing staff, were asked to give an independent judgement for each of a random sample of 381 longstay patients. Thirty percent of the longstay patients were judged eligible for alternative care. They were generally younger, less frequently diagnosed as schizophrenic, better integrated both inside and outside the mental hospital, more likely to be resident of wards with high turnover rates, were less aggressive, had better social skills, and had shorter periods of inpatient stay. Compared with the rest of the patients no statistically significant differences were found with regard to suicidal behaviour, organic brain syndrome and formal admission status.