Health status and ADL functioning of older persons with intellectual disability: community residence versus residential care centers.
Cerebral palsy and Down syndrome, not the home setting, drive daily-living skill loss in aging adults with ID.
01Research in Context
What this study did
Lifshitz et al. (2008) compared older adults with intellectual disability who lived in community homes with those in large residential centers.
They tracked daily-living skills like dressing, bathing, and eating.
The team asked whether the place people lived mattered more than their medical diagnosis.
What they found
Cerebral palsy and Down syndrome predicted steeper skill loss, not the type of home.
Adults with CP showed the fastest decline no matter where they lived.
Down syndrome also aged faster than other ID causes.
How this fits with other research
C-Pitetti et al. (2007) saw the same pattern in hospitals: adults with CP filled wards no matter the setting.
McCarron et al. (2013) widened the lens, showing most adults with ID carry two or more chronic illnesses by their 40s.
Godoy-Giménez et al. (2024) flips the residence question: they found more caregiver abuse in large facilities, so placement still matters for safety even if it does not drive ADL loss.
Why it matters
Stop assuming community placement will slow ADL decline. Instead, flag clients with CP or Down syndrome early and add physical therapy, orthotics, and swallow checks. Use residence decisions for safety and quality of life, not for skill preservation.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Add CP and Down syndrome to your high-risk list; schedule quarterly ADL probes for these clients.
02At a glance
03Original abstract
The objective of the study was to study differences in aging phenomena among adults with intellectual disability (ID), who live in community residence versus their peers in residential care centers and to determine the contribution of health status, age, gender, etiology and level of ID to the decline in ADL function with age. Our study was based on matched pairs between persons with ID in community residence (N=101) and their peers living in residential centers (N=101) by age, gender, etiology and level of ID. Fifty-three percent were aged 40-49 years, 23% were aged 50-59 years and 14% were aged 60-71 years. Ten percent had Down syndrome (DS), 16% had cerebral palsy (CP) and the rest had ID with no specific etiology (NSID). Caregivers were interviewed to ascertain health problems, sensory impairments and activity of daily living (ADL). The type of residence alone could not explain the morbidity and health problems of adults with ID, which were affected by age and etiology. Participants with NSID functioned better than those with Down syndrome or cerebral palsy in all ADL areas. MANOVA and regression analysis indicated that age and health status did not contribute to the explained variance of the ADL function of the participants without specific etiology. The CP group had the most vulnerable etiology exposed to medical problems and decline in ADL function with age. Action should be taken to increase the awareness of the staff to health deterioration that can occur among adult persons with ID, especially among various types of etiologies, such as DS and CP.
Research in developmental disabilities, 2008 · doi:10.1016/j.ridd.2007.06.005