Peripheral arterial disease in older people with intellectual disability in The Netherlands using the ankle-brachial index: results of the HA-ID study.
One in five older adults with ID has silent PAD—screen with ankle-brachial index yearly.
01Research in Context
What this study did
Dutch researchers measured ankle-brachial index in the adults with intellectual disability aged 50 and older.
The test is simple: blood pressure in the ankle is divided by arm blood pressure. A low score shows poor leg circulation.
All lived in community or residential care settings across the Netherlands.
What they found
One in five people had peripheral arterial disease. Almost none of them knew it before the study.
PAD raises heart attack and stroke risk, yet 97 percent of cases were newly discovered.
How this fits with other research
McCarron et al. (2014) found a similar hidden burden in Ireland: three in ten older adults with ID had untreated epilepsy.
DeLeon et al. (2001) tried earlier Dutch health checks and also uncovered many missed problems, but they did not include ABI.
Walton (2016) warns that ageing adults with ID are flooding unprepared health systems; the new PAD numbers prove the point.
Together these papers show a pattern: serious, treatable diseases stay silent until someone looks.
Why it matters
Add a five-minute ankle-brachial index to every annual physical for clients over 50. Early PAD detection lets you refer for exercise therapy, statins, or blood-pressure control before a heart attack happens.
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02At a glance
03Original abstract
Older people with an intellectual disability (ID) have been shown to have similar to increased cardiovascular risks as compared to the general population. Peripheral arterial disease (PAD), atherosclerosis distal from the aortic bifurcation, is associated with increased cardiovascular morbidity and mortality. The prevalence of PAD has not been investigated in this population. Therefore, the aim of the present study was to determine the prevalence of PAD in older people with ID in The Netherlands, the rate of prior diagnoses, and correlations with participant characteristics, and to compare the prevalence with PAD in the general Dutch population. 771 people aged 50 years and over participated in ankle-brachial index (ABI) measurement as part of a multi-centre cross-sectional study (HA-ID study). PAD was defined as an ABI<0.9. After excluding those, who met the exclusion criteria, 629 participants remained. PAD was present in 20.7% of the participants and 97% had not been diagnosed before. People with higher age, smokers and people who lived in central settings, walked with support and were more dependent in activities of daily living were more at risk of PAD. Prevalence of PAD is higher than in the general population (17.4% of 562 eligible participants with ID, as compared to 8.1% of 917 Dutch participants of the PANDORA study, a pan-European study into the prevalence of PAD) through all age groups. Because the high prevalence of PAD implies a serious health risk for older people with ID, we recommend that ankle-brachial index measurement is to be routinely performed as part of the cardiovascular risk management in this group.
Research in developmental disabilities, 2013 · doi:10.1016/j.ridd.2013.02.007