Date of Award

2020

Degree Name

Doctor of Philosophy (School of Physiotherapy)

Schools and Centres

Physiotherapy

First Supervisor

Professor Anne-Marie Hill

Second Supervisor

Associate Professor Caroline Bulsara

Third Supervisor

Associate Professor Shane Patman

Abstract

Adults with intellectual disability (ID) experience earlier age-related changes, compared with other age-matched populations, but concurrently their life expectancy is increasing. Falls often result in serious injuries and reduced health-related quality of life, however there is limited research regarding falls in older adults with ID. The purpose of this research was to investigate falls among community dwelling older adults with ID, including the epidemiology, risk factors and experiences when engaging with health services after a fall.

A meta-analysis of the incidence and prevalence of falls in adults with ID was initially conducted to inform the research aims. Prospective research was then conducted using a mixed methods convergent design, comprising quantitative and qualitative phases. Underpinned by ethical guidelines, a consent procedure was developed with the aim of engaging holistically with older adults with ID throughout the research.

The meta-analysis demonstrated that the pooled proportion of older adults with ID who fell was 39% [95% CI (0.35%-0.43%), very low GRADE evidence]. The developed consent procedure was found to be a respectful method of determining the support older adults with ID required to provide informed consent. The prospective cohort study enrolled 78 participants [median (IQR) age 49 (43-60) years, female n=32 (41%)]. There were 296 falls reported by 36 (46%) participants with 12 participants sustaining one fall and 24 participants sustaining more than one fall. The incidence of falls was 5.7 falls (injurious falls =0.8) per person year. A history of falls [adjusted OR: 6.37, 95% CI (1.90-21.34)] and being ambulant [adjusted OR: 4.50, 95% CI (1.15- 17.67)] were associated with an increased risk of falling. Emergent themes from the qualitative phase of the study (n=17 interviews) demonstrated that participants had limited knowledge about falls. Reporting of falls to health professionals did not prompt access to falls prevention services.

Falls are a substantial health problem for older adults with ID and further research is required to evaluate tailored falls prevention interventions. Guidelines for addressing fall prevention for older adults with ID are urgently required. Older adults with ID should be screened for falls and associated risk factors as part of regular health care.

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