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The incompetent developmentally disabled person's right of self-determination: right-to-die, sterilization and institutionalization.

The developmentally disabled, specifically those mentally incompetent from birth, are entitled to a full panoply of constitutional rights and protections. These rights include the right to terminate life-sustaining treatment, the right of procreative integrity and the right not to be involuntarily institutionalized. However, the mentally incompetent developmentally disabled are generally unable to exercise these rights. This Note asserts first that proper procedural safeguards are necessary to guarantee the exercise of these constitutional rights by the incompetent disabled individual. Second, the Note focuses upon how best to preserve the disabled person's autonomy. The Note subsequently rejects the substituted judgment standard as a legal fiction, and endorses the best interest test which necessarily comports with the evidence, and properly accounts for the disabled person's incompetency.

Humans↗

[Bacteriological examination of saliva of institutionalized severely mentally retarded persons with chronic rumination].

The purpose of this study was to investigate dental caries prevalence, the pH and the presence of bacteria in the saliva of institutionalized severely mentally retarded persons with chronic rumination. The results obtained were as follows: The prevalence of dental caries among the group with chronic rumination was higher than among the group not suffering from rumination. The viable cell number of mutans streptococci, lactobacilli and yeasts in the group with chronic rumination was significantly higher than that of group without rumination. These results suggested that the saliva of the group with chronic rumination creates a favourable environment for aciduric bacterial growth.

Dental Caries↗

Nutritional status, grip strength, and immune function in institutionalized elderly.

The effects of vitamin supplementation on grip strength and immune function was studied in a group of institutionalized elderly with a relatively higher prevalence of low and below acceptable biochemical parameters of vitamin C, pyridoxine, folic acid, riboflavin, iron and zinc nutriture. The vitamin supplementation has resulted in a statistically significant increase in the level of biochemical parameters related to added vitamins, and the number of subjects with inadequate vitamin values was reduced to zero. The improved vitamin status had a positive and statistically significant effect on the delayed cutaneous hypersensitivity one of the parameters of cellular immunity. The calculation of multiple correlation after inclusion of all biochemical parameters into the stepwise regression analysis has shown that the coefficient of multiple regression between examined biochemical parameters of nutrition status and delayed cutaneous hypersensitivity was R = .599 (p less than 0.001) which indicates that about 36% of the variability in the cellular immunity would be affected by the vitamin and mineral nutrition status.

Aged↗

The effects of family structure on institutionalized children's self-concepts.

This study examined the effects of family structure (intact, stepparent, and single parent) on children's self-concepts, using Parish and Taylor's Personal Attribute Inventory for Children. One hundred sixty-six institutionalized children in Grades 5 through 12 participated in the study. Although a trend was noted for students from single-parent families to check fewer positive adjectives, they did not differ significantly (.05 level) from children from intact families or stepfamilies.

Child↗

[The problem of screening for HIV infection in mentally retarded institutionalized subjects].

Screening programs for the acquired immunodeficiency syndrome have been proposed to several categories of persons at increased risk for AIDS. On the other hand, it is still controversial if people with mental retardation may be candidates for mandatory screening. In our opinion, the reduced competence and diminished autonomy that characterize institutionalized mentally retarded subjects, it might be appropriate those who are uninfected from possible human immunodeficiency virus infection.

Acquired Immunodeficiency Syndrome↗

Observer-rated functional assessments for institutionalized elders.

A content analysis was conducted of 320 units of observational data generated on 40 randomly selected institutionalized and uncommunicative elders over a 5-day (220-hour) period. When existing observer-rated instruments were compared with observational data, using a six-dimensional theoretical framework, gaps in the existing instruments became apparent. Future research and development of functional assessments should include observer-rated criteria for health and well-being for the affective dimension of functioning and criteria for determining mental judgment in uncommunicative elders.

Activities of Daily Living↗

Nutritional status of a group of institutionalized elderly people in Perugia (Italy).

In this group of institutionalized elderly people the anthropometry and body composition situation is much better than that observed in a noninstitutionalized group examined longitudinally on a previous occasion. On the other hand, as expected, indices of physical activity are lower. The diet is in general satisfactory, considering the very low physical activity of those individuals. Only a few foods and nutrients show marginal low intakes (fish, eggs and legumes; lipids, iron, thiamin and vitamin A).

Aged↗

Nutritional status of institutionalized elderly people in north Italy.

The nutritional status of 91 institutionalized elderly people over 60 years of age was investigated. Particular attention was given to diet, body composition and some biochemical determinations of vitamin nutriture. It was found that approximately 40% of the population are at risk for obesity. Mean daily intake of nutrients, compared with the recommended values for Italy, is insufficient in thiamin, both for men and for women, and in vitamin A for women. The level of fat in the diet is higher than desired. Consumption of eggs, fish, legumes and sweets is low, while milk and dairy products are consumed in large quantities. Thiamin and riboflavin nutriture determined by biochemical tests is not significantly correlated to dietary intake.

Age Factors↗

Vitamin B6 status measures of an institutionalized mentally retarded population.

Intake and functional measurements of vitamin B6 were assessed for 40 institutionalized mentally retarded persons. Dietary intake was determined by observations during a 3-day period. Diets contained a mean of 1.6 mg/day of vitamin B6. The saturation of red cell aspartic transaminase was determined as a functional measurement of cellular B6 status. The mean saturation level did not differ significantly from a control group. There was a significant nonlinear correlation of intake and saturation level; 20% of the subjects fell below the level regarded as adequate. Although many of the subjects were receiving a variety of drugs, correlation of these data indicates that total intake of the vitamin accounted for most of the variability of the data. Protein and calorie intake were also examined.

Adult↗

Increased serum IgE antibodies in institutionalized asthmatic children after a transient return home. The role of house dust mite allergens in the home as a trigger of asthmatic attacks in mite-sensitive patients.

Increased serum IgE antibodies to Dermatophagoides pteronyssinus, a house dust mite, were observed in 12 of 13 institutionalized mite-sensitive asthmatic children after returning for four days to their own homes. These results implicate the house dust mite as a trigger of asthmatic attacks in these patients.

Adolescent↗

Adaptive Behavior Scale Cognitive Triad: discrimination and classification of institutionalized mentally retarded adults.

The Leiter International Performance Scale, the Peabody Picture Vocabulary Test-Revised, and the Cognitive Triad of the Adaptive Behavior Scale were used to assess the intellectual functioning of 77 institutionalized mentally retarded adults. On the basis of their IQs, 30 were categorized as profoundly, 21 as severely, and 16 as moderately retarded (10 were unclassifiable because the Leiter and Peabody yielded disparate scores). Discriminant analysis in which category membership was predicted on the basis of the Cognitive Triad measures (Economic Activity, Language Development, and Number and Time Concepts) correctly classified 78% of the cases. There were no instances in which profoundly and moderately retarded individuals were mutually misclassified. Results support the use of the Cognitive Triad as an alternative for classifying lower functioning retarded persons.

Adaptation, Psychological↗

Appropriate and inappropriate use of psychotherapeutic medications for institutionalized mentally retarded persons.

Evaluation of psychiatric treatment in institutions must be based not only on the numbers and types of drugs prescribed but also on diagnoses and other characteristics of the patients. We crosstabulated psychotherapeutic medication regimens against diagnoses for 242 institutionalized mentally retarded adolescents and adults selected for psychiatric treatment. The drugs had generally been prescribed by nonpsychiatrists, but diagnoses were determined by consensus of evaluation teams that included fully trained psychiatrists. According to widely accepted standards for psychopharmacologic treatment, 45.4% to 60.9% of the regimens were rated as appropriate and 39.1% to 54.6% were rated as inappropriate for the conditions diagnosed.

Adolescent↗

Prediction of developmental attainments of institutionalized mentally retarded children.

Two regression equations using chronological age and either IQ or the Fisher and Zeaman K score were developed to predict Developmental Record ratings of institutionalized mentally retarded children over a 2-year interval (N = 200), a 4-year interval (N = 165), and an 8-year interval (N = 95). Although the correlations between predicted and obtained scores for both equations were quite high even over an 8-year interval, analysis of mean differences revealed that the equation using IQ yielded more accurate predictions. If future studies support the use of such equations with other subjects in other settings, they should be useful in estimating later developmental attainments of mentally retarded children.

Activities of Daily Living↗

Nutritional status of the institutionalized elderly.

The nutritional status of 84 elderly ambulant, self-feeding residents in public institutions was evaluated in terms of their food supply and the biochemical constituents in their blood. Calculations were made of the energy, protein, vitamin and iron composition of the food supply in the institution. The amount of nutrients supplied were adequate when compared with the recommended dietary allowances. Deficiency levels in the blood (expressed as a percentage of the population) were found in the following constituents; riboflavin 46%, hemoglobin 44%, plasma carotene 34%, thiamine 19%, leukocyte ascorbic acid 20%, retinol 5%, and plasma iron 2%. No deficiency was found in pyridoxine. Problems of monitoring the nutritional status of the institutionalized elderly are discussed.

Aged↗

Individual and family factors associated with risk of institutionalization of mentally retarded adults.

A demographic description of the individual and family characteristics of mentally retarded persons referred for placement at a state residential facility in 1982 was presented. Three outcome dispositions (continued home placement, institutional placement, and community residential placement) were considered. Findings suggest that measurements of risk of institutionalization must be expanded beyond personal characteristics of retarded individuals to include stress factors within the family.

Activities of Daily Living↗

Some correlates of language deterioration in severely and profoundly retarded long-term institutionalized residents.

Progress or deterioration in language use was observed in two samples of retarded institutionalized residents. One sample was observed twice, and the other three times, at 5-year intervals. We coded change in language use as noncommunicating, regressed irregular, stable, or progressed. Change in language use was found to be related to two indicators of intellectual capacity. Central nervous system involvement may play a part in irregular or totally absent communication. Institutional policies regarding transfer of residents also affect the apparent language deficit in longer-term residents.

Age Factors↗

Hypochondriasis and paranoia: similar delusional systems in an institutionalized geriatric population.

Hypochondriasis and paranoia are common psychopathologies of aging. The former may be secondary to depression or organic brain syndrome, whereas the latter may be secondary to sensory impairment or organic brain syndrome. Paranoid schizophrenia, with delusions of grandeur, is rare in later life. The authors classified 273 institutionalized geriatric patients by means of staff ratings into categories such as lucid and alert, confused, hypochondriacal, paranoid, etc. Among confused patients there was a correlation of .45 (p less than .001) between hypochondriasis and paranoia. Even among nonconfused patients, there was a slight positive correlation. The authors concluded that geriatric paranoia and hypochrondriasis have similar structure (delusion) and functions (safeguarding self-esteem and manipulating others). An interpersonal perspective can also provide guidelines for when to treat these conditions.

California↗

Effects of social and environmental change on institutionalized mentally retarded persons: the relocation syndrome reconsidered.

The "relocation syndrome" in multiply-handicapped, institutionalized mentally retarded residents was examined in an observational study. Weight change and the initiation and duration of constructive and nonconstructive behavior was observed, as well as resident-staff interactions before and after relocation to a new living unit. The hypothesis that there would be an increase in behavior deleterious to the health of clients after relocation, when compared to two premove baseline periods of crowding, was not totally supported. Although relocation did cause significant changes in a variety of behaviors, not all were deleterious (i.e., no mortalities, weight gains). Results were discussed in terms of a social-situational model.

Adolescent↗