Associations between behavior disorders and health status among older adults with intellectual disability.

Few studies have examined the relationship of behavior and health status among aging persons with intellectual and developmental disabilities (I/DD). Behavioral disorders, which often are coincident with functional decline in older persons with I/DD, may be more related to medical morbidity than previously reported. This cross-sectional study examined the association between health status and behavior disorders with increasing age in a cohort of 60,752 adults with I/DD clustered into four adult-age groupings (21-44, 45-59, 60-74, and >74). Age grouping data suggested an association between morbidity and increased likelihood of behavior symptoms in all but the oldest age grouping. The magnitude of the association and trend varied by specific disease across age groupings compared to that found in healthy cohorts. About 25% of the adults with I/DD had psychiatric diagnoses and the frequency of such diagnoses did not decrease with age grouping. These results suggest that adverse health status may increase the likelihood of persistent behavioral disturbances in older persons with I/DD. Moreover, behavioral disorders may be sentinels for occult medical morbidity, which in turn may be responsive to intervention.

Characteristics of older adults with intellectual disabilities referred for crisis intervention.

The aim of the present study was to identify the age correlates of behavioural crises in adults with intellectual disability (ID) living in the community. The cohort consisted of 185 clients (IQ < 70), ranging in age from 20 to > 70 years, who were referred to a crisis intervention programme specializing in services to individuals with dual diagnosis over a 7-year period. A retrospective cross-sectional analysis of historical and contemporaneous variables was completed. Referrals for crisis intervention were not related to the age of the client Aggression and non-compliant behaviour occurred with similar frequency in all age groups. Other behaviours, including withdrawal, self-injury, stereotypy and symptoms of psychiatric disorders, occurred less often in older clients. Severity of ID affected the pattern of behavioural crises that resulted in referral. The results suggest that people with ID residing in community settings still experience behavioural crises as they grow older. Confirmation of the trends reported in the present study might signal a need for accelerating the development of comprehensive age-span community mental health and behavioural supports.

Factors predicting re-referral following crisis intervention for community-based persons with developmental disabilities and behavioral and psychiatric disorders.

Characteristics of 98 clients re-referred to receive services from a community-based crisis intervention program were compared to those of program clients who were served during the same 5.25-year period who were not referred. The majority of re-referrals occurred because of the same challenging behavior causing initial referral. Eight-eight percent of re-referral clients received the additional referral by 2 years after initial discharge. For persons under 30, nonfamily residence and initial diagnosis of self-injurious behavior were the strongest predictors. For those over 30, the most important factor was aggression. Recidivism following crisis intervention appears to be a complex function of client characteristics and community capabilities.

Postpartum laparoscopy for sterilization.

The necessity of performing sterilization in the immediate postpartum period is evident in many areas of the world. Tubal ligation via laparotomy may extend the postpartum stay and entail a certain morbidity. We have applied the technique of tubal coagulation and or resection via laparoscope to a large series of patients shortly after parturition. The technique is readily acquired, complications have been minimal, and in most instances, postpatum stay is not extended. A portion of these patients were followed by hysterosalpingogram approximately 3 months postpartum at which time tubal occlusion was demonstrated. We conclude that this procedure is not contraindicated in the postpartum period.