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    The second half of the 20th century vastly increased the life span of those with mental retardation (MR). Today the average life expectancy of older adults with MR is 66.1 years and growing. As these individuals age, they present increasing challenges to the clinician. Increased rates of hearing and visual impairments, obesity, and osteoporosis as well as high rates of dementia with associated psychiatric problems make care for the aging individual with MR complex. Primary care providers need to be aware that elders with MR will comprise an increasing part of their practice, and that they present with many chronic conditions.

    Fisher K, Kettl P. Aging with mental retardation: Increasing population of older adults with MR require health interventions and prevention strategies. Geriatrics 2005; 60(April):26-29.

    Key words: mental retardation • Down's syndrome • deinstitutionalization









    Improvements in institutional care and residential placements as well as advances in assistive technology and public health programs have enhanced the quality of life for individuals with mental retardation (MR). Indeed, gains in life expectancy for those with MR are one of the clear public health success stories for the second half of the 20th century. Currently, the average life expectancy of persons with MR is 66 years.1 However, younger adults with MR can expect to live as long as their non-MR peers—76.9 years.1 Individuals with Down's Syndrome (DS), the most common cause of MR in America, have experienced a doubling in life expectancy. In 1983, the average lifespan for an individual with DS was 25 years; by 1997, it had increased to 49 years.2

    Because of increased longevity, individuals with MR confront the same chronic illnesses (ie, cardiovascular disease, cancer, diabetes) that affect the general aging population. Management of these illnesses is typically accomplished with caregiver supervision or, in some cases, independently. In either situation, providers will need to allow additional time for health education and health maintenance practices with this population. These individuals experience an increased prevalence of certain conditions including thyroid disease, seizure disorders, mental health disorders, obesity, ocular anomalies, and poor oral health.3 Health interventions and prevention strategies exist to address the chronic illnesses and special needs of the MR patient, but not everyone benefits equally or has access to health care. Those with MR are less likely to receive adequate medical services compared with those in the general population, even though they have more physical and chronic health problems.1,4

    The emerging population of older patients with MR will add costs to an already strapped healthcare system. An analysis of costs in the Netherlands attributes 9% of all disease-specific costs of health care to MR.5 Primary care providers (PCPs) therefore must be familiar with managing the health care needs of this "new" geriatric population. The challenge is to enhance the overall functioning of the aging individual with MR, while allowing them to retain independence for as long as possible. This article will identify common health problems in elders with MR, especially those with DS.

    Systemic age-related changes Visual impairment Visual impairment, including cataracts, keratoconus, refractive errors, strabismus, nystagmus, corneal abnormalities, and hyperplasia are common in patients with MR. Uncorrected refractive errors are identified as the most common cause of decreased vision within this population.1 While these are typical age-related changes, those with MR may not receive routine eye care. Routine annual eye examinations are recommended for all adults over age 65 and include visual acuity and glaucoma screening. 6 Moreover, severity of MR is associated with an increased prevalence of visual impairments.7

    Adults with DS are at higher risk for vision problems and experience these changes (including cataracts, refractive errors, retinopathy, and glaucoma) at earlier ages (ie, >age 35). In one study examining the vision of patients with DS between ages 50 and 59, approximately one-half had moderate to severe visual loss.8 Another survey found that 50% of those with DS over age 50 had cataracts,9 while in the non-MR population only mild lens opacities are typically evident at age 50.10

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    The second half of the 20th century vastly increased the life span of those with mental retardation (MR). Today the average life expectancy of older adults with MR is 66.1 years and growing. As these individuals age, they present increasing challenges to the clinician. Increased rates of hearing and visual impairments, obesity, and osteoporosis as well as high rates of dementia with associated psychiatric problems make care for the aging individual with MR complex. Primary care providers need to be aware that elders with MR will comprise an increasing part of their practice, and that they present with many chronic conditions.

    Fisher K, Kettl P. Aging with mental retardation: Increasing population of older adults with MR require health interventions and prevention strategies. Geriatrics 2005; 60(April):26-29.

    Key words: mental retardation • Down's syndrome • deinstitutionalization









    Improvements in institutional care and residential placements as well as advances in assistive technology and public health programs have enhanced the quality of life for individuals with mental retardation (MR). Indeed, gains in life expectancy for those with MR are one of the clear public health success stories for the second half of the 20th century. Currently, the average life expectancy of persons with MR is 66 years.1 However, younger adults with MR can expect to live as long as their non-MR peers—76.9 years.1 Individuals with Down's Syndrome (DS), the most common cause of MR in America, have experienced a doubling in life expectancy. In 1983, the average lifespan for an individual with DS was 25 years; by 1997, it had increased to 49 years.2

    Because of increased longevity, individuals with MR confront the same chronic illnesses (ie, cardiovascular disease, cancer, diabetes) that affect the general aging population. Management of these illnesses is typically accomplished with caregiver supervision or, in some cases, independently. In either situation, providers will need to allow additional time for health education and health maintenance practices with this population. These individuals experience an increased prevalence of certain conditions including thyroid disease, seizure disorders, mental health disorders, obesity, ocular anomalies, and poor oral health.3 Health interventions and prevention strategies exist to address the chronic illnesses and special needs of the MR patient, but not everyone benefits equally or has access to health care. Those with MR are less likely to receive adequate medical services compared with those in the general population, even though they have more physical and chronic health problems.1,4

    The emerging population of older patients with MR will add costs to an already strapped healthcare system. An analysis of costs in the Netherlands attributes 9% of all disease-specific costs of health care to MR.5 Primary care providers (PCPs) therefore must be familiar with managing the health care needs of this "new" geriatric population. The challenge is to enhance the overall functioning of the aging individual with MR, while allowing them to retain independence for as long as possible. This article will identify common health problems in elders with MR, especially those with DS.

    Systemic age-related changes Visual impairment Visual impairment, including cataracts, keratoconus, refractive errors, strabismus, nystagmus, corneal abnormalities, and hyperplasia are common in patients with MR. Uncorrected refractive errors are identified as the most common cause of decreased vision within this population.1 While these are typical age-related changes, those with MR may not receive routine eye care. Routine annual eye examinations are recommended for all adults over age 65 and include visual acuity and glaucoma screening. 6 Moreover, severity of MR is associated with an increased prevalence of visual impairments.7

    Adults with DS are at higher risk for vision problems and experience these changes (including cataracts, refractive errors, retinopathy, and glaucoma) at earlier ages (ie, >age 35). In one study examining the vision of patients with DS between ages 50 and 59, approximately one-half had moderate to severe visual loss.8 Another survey found that 50% of those with DS over age 50 had cataracts,9 while in the non-MR population only mild lens opacities are typically evident at age 50.10

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    Paul Kettl, MD, MHA
    Dr. Kettl is professor of psychiatry, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pa.
    Kathleen Fisher, PhD, CRNP
    Dr. Fisher is associate professor, college of nursing and health professions, Drexel University, Philadelphia.