The impact of living arrangements and deinstitutionalisation in the health status of persons with intellectual disability in Europe.
Adults with ID living with family or independently across Europe miss basic preventative care and carry high rates of obesity and illness.
01Research in Context
What this study did
Mount et al. (2011) asked one big question: does the place a person with intellectual disability lives shape their health? They mailed surveys to 15 European countries. Staff reported on weight, illness, exercise, shots, and cancer checks for adults in three settings: still in institutions, living with family, or on their own/small group homes.
They also noted how long each country had been closing large institutions. Early-deinstitutionalisation countries were compared with late movers.
What they found
Obesity, inactivity, and several chronic illnesses were common everywhere. Shockingly, countries that closed institutions early had higher rates of some diseases. Family homes and independent settings scored worst on basic prevention: missed flu shots, cancer screenings, and dental visits lagged far behind institutional rates.
How this fits with other research
Rimmer et al. (1995) saw the same pattern in the USA sixteen years earlier: adults in group or family homes had poorer health markers than those still in institutions. Mount et al. (2011) now shows the gap has not closed, and it spans an entire continent.
Ricciardi et al. (2006) proved a one-off health review can catch dozens of hidden problems as people leave institutions. The new survey says those checks are still missing for most once they settle in family or community homes.
Hsieh et al. (2015) later linked low community access to even higher obesity. Together the papers build a chain: deinstitutionalisation → less medical oversight → rising weight and illness unless we act.
Why it matters
If you support adults with ID in family or independent homes, treat the house like a mini-clinic. Build yearly shot and screening calendars into the ISP. Add home-based exercise chunks: 10-minute walks before meals, standing chores, early bedtimes (Jacques et al. 2014 show early risers move more). Without these steps, community living can unintentionally trade confinement for preventable disease.
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02At a glance
03Original abstract
BACKGROUND: Despite progress in the process of deinstitutionalisation, very little is known about the health conditions of people with intellectual disability (PWID) who live in large institutions and PWID living in small residential services, family homes or independent living within the community. Furthermore, there are no international comparison studies at European level of the health status and health risk factors of PWID living in fully staffed residential services with formal support and care compared with those living in unstaffed family homes or independent houses with no formal support. METHODS: A total of 1269 persons with ID and/or their proxy respondents were recruited and face-to-face interviewed in 14 EU countries with the P15, a multinational assessment battery for collecting data on health indicators relevant to PWID. Participants were grouped according to their living arrangements, availability of formal support and stage of deinstitutionalisation. RESULTS: Obesity and sedentary lifestyle along with a number of illnesses such as epilepsy, mental disorders, allergies or constipation were highly prevalent among PWID. A significantly higher presence of myocardial infarctions, chronic bronchitis, osteoporosis and gastric or duodenal ulcers was found among participants in countries considered to be at the early stage of deinstitutionalisation. Regardless of deinstitutionalisation stage, important deficits in variables related to such medical health promotion measures as vaccinations, cancer screenings and medical checks were found in family homes and independent living arrangements. Age, number of people living in the same home or number of places in residential services, presence of affective symptoms and obesity require further attention as they seem to be related to an increase in the number of illnesses suffered by PWID. DISCUSSION: Particular illnesses were found to be highly prevalent in PWID. There were important differences between different living arrangements depending on the level of formal support available and the stage of deinstitutionalisation. PWID are in need of tailored primary health programs that guarantee their access to quality health and health promotion and the preventative health actions of vaccination programs, systematic health checks, specific screenings and nutritional controls. Extensive national health surveys and epidemiological studies of PWID in the EC member states are urgently needed in order to reduce increased morbidity rates among this population.
Journal of intellectual disability research : JIDR, 2011 · doi:10.1111/j.1365-2788.2011.01439.x