Caregivers' reported functional limitations in activities of daily living among middle-aged adults with intellectual disabilities.
Half of adults with ID stay fully independent past 45, but those with Down syndrome or profound ID need mobility-focused supports now.
01Research in Context
What this study did
Lin et al. (2013) asked caregivers to rate daily-living skills of 480 Taiwanese adults with intellectual disability. All participants were at least 45 years old.
The team used the Barthel Index, a quick checklist for bathing, dressing, toilet use, walking, and similar tasks. They also noted education level, Down syndrome status, and disability severity.
What they found
Half of the adults scored fully independent on the Barthel Index. The other half needed some or total help.
Lower education, Down syndrome, and profound ID each predicted lower scores. In short, these groups are the first to lose everyday skills.
How this fits with other research
Bauman et al. (1996) tracked the same age group over time and saw skills drop fastest after age 60, especially in adults with Down syndrome. Lan-Ping’s snapshot agrees: Down syndrome already shows lower scores by 45.
Laxton et al. (2026) added a health twist. They found adults who need more ADL help also sit almost eight hours a day. The link is clear—less independence, more sedentary time.
Amore et al. (2011) looked at 989 older adults and concluded mobility, not IQ level, drives daily skills. Lan-Ping’s data support this; walking items on the Barthel were among the first to fail.
Why it matters
Use the Barthel at intake and every annual review. Flag clients with Down syndrome or profound ID early. Add mobility goals and brief standing or walking breaks every 30 minutes—Paige’s sedentary data show this extra step matters. Target these same clients for stair practice, balance games, or supported grocery trips. Keeping them moving keeps them independent longer.
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02At a glance
03Original abstract
This study was conducted to describe the functioning of Activities of Daily Living (ADL) and to examine socio-economic effects on ADL functioning among adults with intellectual disabilities (ID) aged 45 years and older (N=480) in Taiwan. The Barthel Index (BI) was used to determine a baseline level of ADL functioning in the study participants. There are five categories of functional impairment using the following cut-off values in Taiwan: total dependence (BI score 0-20), severe (BI score 21-60), moderate (BI score 61-90), mild (BI score 91-99), and total independence (BI score 100) (Taiwan Department of Health, 2012). The results revealed that 2.3% of adults with ID were in total dependence, 11.9% were in severe dependence, 27.9% were in moderate dependence, 8.1% had a mild dependence, and 49.8% were totally independent. In the multiple linear regression model of the ADL score, we determined that educational level, comorbid Down's syndrome, and disability level are the variables able to significantly predict ADL score (R(2)=0.190) after controlling for the factors of age, marital status, and other comorbidity conditions. Those ID adults with a lower education level (primary vs. literate, β=4.780, p=0.031; intermediate vs. literate, β=6.642, p=0.030), with comorbid Down's syndrome (β=-7.135, p=0.063), and with a more severe disability condition (severe vs. mild, β=-7.650, p=0.007; profound vs. mild, β=-19.169, p<0.001) had significantly lower ADL scores. The present study highlights the need to support mobility in older adults with ID as much as possible to optimize independence in this group.
Research in developmental disabilities, 2013 · doi:10.1016/j.ridd.2013.09.038