Continuity and change in the use of residential services by adults with intellectual disability: the Aberdeen cohort at mid-life.
Half of adults with ID move to community homes by mid-life, yet hospital stays grow longer and sicker for those who still need them.
01Research in Context
What this study did
Researchers followed the adults with intellectual disability in Aberdeen, Scotland. All had entered services in the 1970s. The team tracked where each person lived every few years for 20 years.
They simply counted who moved and who stayed. Moves could be from hospital to group home, parent home to supported flat, or no change at all.
What they found
By their 40s, half had left hospitals or parents' homes and now lived in community houses or flats. The other half had not moved at all.
No one moved back to a hospital once they left. Once in the community, they stayed there.
How this fits with other research
Prigge et al. (2013) looked at England-wide hospital data 13 years later. They found ID admissions had dropped 50 percent, but when adults with mild ID did enter, their stays had doubled from 131 to 244 days. The Aberdeen picture of steady community living is therefore only half the story; hospitals are still used, just for fewer but longer stays.
Lin et al. (2011) asked Taiwanese managers about the same aging cohort. Managers agreed people with ID now age earlier, yet services lack medical, money, and daily-living supports. The Aberdeen adults may be in the community, but supports have not caught up with their health needs.
Pitchford et al. (2019) followed older Scottish adults with ID and showed 30-day hospital readmissions spike for nerve, bone, and breathing problems. Community living is safer only if discharge plans watch these body systems closely.
Why it matters
If you write transition plans, expect two groups: one ready for quick community placement, one that will stay put for decades. Screen both for early-aging conditions around age 40. Build hospital discharge checks for nerve, bone, and breathing issues, and secure long-term medical follow-up. Community homes are now the norm, but length and complexity of care are rising.
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02At a glance
03Original abstract
The present paper reports a follow-up study of a representative cohort of people with intellectual disability, now in middle age, who entered adult services on leaving school in the late 1960s, and whose adult years have coincided with a period of radical policy change and considerable service expansion. The present authors focus on the changes which have taken place in their use of residential services over this period. Firstly, the situation in early adulthood when they were last studied is examined. At this time, 60% of the cohort were still living at home, almost all with both parents. The remaining 40% were in institutions, mainly long-stay mental handicap hospitals. Out-of-home placement is associated with gender (maleness), challenging behaviour, and the absence of one or both parents. The present authors compare this with the situation 20 years later. The most significant change in this time is the expansion of the community sector, accounting for about half of the surviving cohort, with numbers still at home or in hospital correspondingly reduced. Almost half of the cohort had experienced little or no change in residential situation. On average, they were less intellectually and socially able than those who had moved into community provision.
Journal of intellectual disability research : JIDR, 2000 · doi:10.1046/j.1365-2788.2000.00256.x