Health  Vol.5 No.4 , April 2013
The influence of environment, predisposing, enabling and need variables on personal health choices of adults with intellectual disability

Attention to disease and risk factor management is increasingly a feature of people with intellectual disability (ID) as an augmented life expectancy also exposes a growing number of age-related diseases. An additional concern is little attention to date to physical activity, nutrition, access to social support and other personal health choices and to environmental issues such as the impact of access to social support and the implications of individual’s living arrangements. Method: Using a sample of 753 persons with ID from the intellectual disability supplement to the Irish longitudinal study on ageing (IDS-TILDA), forty three variables were grouped into environmental, predisposing, enabling, need and personal health choices clusters and hierarchical ordinary least squares regression examined the contribution of environmental, enabling, predisposing, need and all combinations of the sets of variables to personal health choices. Findings: Almost 32% of variance was explained primarily by need variables. Most significant relationships were with meeting up with family and friends (environmental), age, rating of health and worries about getting older (predisposing), having public health insurance and nursing who come into the home (enabling) and presence of stroke, chronic constipation, functional limitations, high assistance needs with activities of daily living (need). Discussion: Taken together, the groupings of variables from the Anderson Model explained a modest amount of variance in the pursuit of positive personal health choices by people with ID. More work is clearly needed in developing evidence-based interventions and strategies, and in understanding the relationship between positive personal health choices of people with ID and health outcomes.

Cite this paper: McCallion, P. , Burke, E. , Swinburne, J. , McGlinchey, E. , Carroll, R. and McCarron, M. (2013) The influence of environment, predisposing, enabling and need variables on personal health choices of adults with intellectual disability. Health, 5, 749-756. doi: 10.4236/health.2013.54099.

[1]   Janicki, M.P., Dalton, A.J., Henderson, C.M. and Davidson, P.W. (1999) Mortality and morbidity among older adults with intellectual disability: Health services considerations. Disability Rehabilitation, 21, 284-294. doi:10.1080/096382899297710

[2]   Janicki, M.P. and Dalton, A.J. (2000) Prevalence of dementia and impact on intellectual disability services. Mental Retardation, 38, 276-288. doi:10.1352/0047-6765(2000)038<0276:PODAIO>2.0.CO;2

[3]   Hilgenkamp, T.I.M., Reis, D., van Wijck, R. and Evenhuis, H.M. (2012) Physical activity levels in older adults with intellectual disabilities are low. Research in Developmental Disabilities, 33, 477-483. doi:10.1016/j.ridd.2011.10.011

[4]   Reimers, C.D., Knapp, G. and Reimers, A.K. (2012) Does physical activity increase life expectancy? A review of the literature. Journal of Aging Research, 2012, 243958, 9 pages. doi:10.1155/2012/243958

[5]   Shikany, J.M. and White Jr., G.L. (2000) Dietary guidelines for chronic disease prevention. Southern Medical Journal, 93, 1138-1151.

[6]   Hayes, J.C. (2002) Living arrangements and health status in later life: A review of recent literature. Public Health Nursing, 5, 136-151. doi:10.1046/j.1525-1446.2002.00209.x

[7]   Hurdle, D.E. (2001) Social support: A critical factor in women’s health and health promotion. Health & Social Work, 26, 72-79. doi:10.1093/hsw/26.2.72

[8]   Uchino, B. (2009). Understanding the links between social support and physical health: A life-span perspective with emphasis on the separability of perceived and received support. Perspectives on Psychological Science, 4, 236-255. doi:10.1111/j.1745-6924.2009.01122.x

[9]   US Department of Health and Human Services (2002) Health Centers: America’s Primary Care Safety Net Reflections on Success, 2002-2007. US Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Washington DC.

[10]   Haveman, M., Heller, T., Lee, L., Maaskant, M., Shooshtari, S. and Strydom, A. (2010) Major health risks in aging persons with intellectual disabilities: An overview of recent studies. Journal of Policy and Practice in Intellectual Disabilities, 7, 59-69. doi:10.1111/j.1741-1130.2010.00248.x

[11]   Van Schrojenstein Lantman De Valk, H.M., Metsemakers, J.F., Haveman, M.J. and Crebolder, H.F. (2000) Health problems in people with intellectual disability in general practice: A comparative study. Family Practice, 17, 405- 407.

[12]   Fletcher, R., Loschen, E., Stavrakaki, C. and First, M. (2007) Diagnostic manual-intellectual disability. NADD and APA, Kingston.

[13]   De Winter, C.F., Bastiaanse, L.P., HilgenKamp, T.I.M., Evenhuis, H.M. and Echteld, M.A. (2012) Overweight and obesity in older people with intellectual disability. Research in Developmental Disabilities, 33, 398-405. doi:10.1016/j.ridd.2011.09.022

[14]   McCarron, M., Swinburne, J., Burke, E., McGlinchey, E., Mulryan, N., Andrews, V., Foran S. and McCallion, P. (2011) Growing older with an intellectual disability in Ireland 2011: First results from the intellectual disability supplement of the Irish longitudinal study on ageing. School of Nursing & Midwifery, Trinity College, Dublin.

[15]   Evenhuis, H.M., Theunissen, M., Denkers, I., Verschuure, H. and Kemme H. (2001) Prevalence of visual and hearing impairment in a Dutch institutionalized population with intellectual disability. Journal Intellectual Disability Research, 45, 457-464. doi:10.1046/j.1365-2788.2001.00350.x

[16]   WHO (2001) International classification of functioning, disability and health. World Health Organization, Geneva.

[17]   Cooper, S.A., Melville, C. and Morrison J. (2004) People with intellectual disabilities. Their health needs differ and need to be recognized and met. British Medical Journal, 329, 414-415. doi:10.1136/bmj.329.7463.414

[18]   Strauss, D., Kastner, T.A. and Shavelle, R. (1998) Mortality of adults with developmental disabilities living in California institutions and community care, 1985-1994. Mental Retardation, 36, 360-371. doi:10.1352/0047-6765(1998)036<0360:MOAWDD>2.0.CO;2

[19]   McCarron, M. and Lawlor, B. (2003) Responding to the challenges of ageing and dementia in intellectual disability in Ireland. Aging and Mental Health, 7, 413-417. doi:10.1080/13607860310001594655

[20]   Iacono, T. and Sutherland, G. (2006) Health screening and developmental disability. Journal of Policy and Practice in Intellectual Disability, 3, 155-163. doi:10.1111/j.1741-1130.2006.00075.x

[21]   Suzuki, R., Krahn, G.L., McCarthy, M.J. and Adams, E.J. (2007) Understanding health outcomes: Physical seconddary conditions in people with spinal cord injury. Rehabilitation Psychology, 52, 338-350. doi:10.1037/0090-5550.52.3.338

[22]   Rimmer, J.H., Chen, M.-D. and Hsieh, K. (2011) A conceptual model for identifying, preventing and managing secondary conditions in people with disabilities. Physical Therapy, 91, 1728-1739. doi:10.2522/ptj.20100410

[23]   Hughes, R.B. (2006) Achieving effective health promotion for women with disabilities. Family Community Health, 29, 44S-51S. doi:10.1097/00003727-200601001-00008

[24]   Rimmer, J.H. and Rowland, J.L. (2008) Health promotion for people with disabilities. American Journal of Lifestyle Medicine, 10, 1-12.

[25]   Haveman, M., Heller, T., Maaskant, M., Lee, L., Shooshtari, S. and Strydom, A. (2009) Health risks in older adults with intellectual disabilities: A review of studies (IASSID report).

[26]   Cooper, S.A., Morrison, J., Melville, C., Finlayson, J., Allan, L., Martin, G. and Robinson, N. (2006) Improving the health of people with intellectual disabilities: Outcomes of a health screening programme after 1 year. Journal of Intellectual Disability Research, 50, 667-677. doi:10.1111/j.1365-2788.2006.00824.x

[27]   Lennox, N., Bain, C., Rey-Conde, T., Purdie, D., Bush, R., and Pandeya, N. (2007) Effects of a comprehensive health assessment programme for Australian adults with intellectual disability: A cluster randomized trial. International Journal of Epidemiology, 36, 139-146. doi:10.1093/ije/dyl254

[28]   Anderson, R.M. (1995) Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36, 1-10. doi:10.2307/2137284

[29]   Kelly, C. and Kelly, F. (2011) Annual Report of the National Intellectual Disability Database Committee. Health Research Board, Dublin.

[30]   Green, S.B. (1991) How many subjects does it take to do a regression analysis? Multivariate Behavioral Research, 26, 499-510. doi:10.1207/s15327906mbr2603_7

[31]   Albert, M. and Cohen, C. (1992) The test for severe impairment. Journal of American Geriatric Society, 40, 449- 453.

[32]   Barrett, A., Savva, G., Timonen, V. and Kenny, R.A. (2011) Fifty Plus in Ireland 2011, First Results from the Irish Longitudinal Study on Ageing. Trinity College, Dublin.

[33]   HSE (2011) Time to Move on from Congregated Settings: A Strategy for Community Inclusion Report of the Working Group on Congregated Settings. Health Service Executive, Dublin.