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Effect of deinstitutionalisation on quality of life for adults with intellectual disabilities: a systematic review.

ABSTRACT: OBJECTIVE:To review systematically the evidence on how deinstitutionalisation affects quality of life (QoL) for adults with intellectual disabilities. DESIGN:Systematic review. POPULATION:Adults (aged 18 years and over) with intellectual disabilities. INTERVENTIONS:A move from residential to community setting. PRIMARY AND SECONDARY OUTCOME MEASURES:Studies were eligible if evaluating effect on QoL or life quality, as defined by study authors. SEARCH:We searched MEDLINE, PsycINFO, CENTRAL, CINAHL, EconLit, Embase and Scopus to September 2017 and supplemented this with grey literature searches. We assessed study quality using the Critical Appraisal Skills Programme suite of tools, excluding those judged to be of poor methodological quality. RESULTS:Thirteen studies were included; eight quantitative studies, two qualitative, two mixed methods studies and one case study. There was substantial agreement across quantitative and qualitative studies that a move to community living was associated with improved QoL. QoL for people with any level of intellectual disabilities who move from any type of institutional setting to any type of community setting was increased at up to 1?year postmove (standardised mean difference [SMD] 2.03; 95%?CI [1.21 to 2.85], five studies, 246 participants) and beyond 1?year postmove (SMD 2.34. 95%?CI [0.49 to 4.20], three studies, 160 participants), with total QoL change scores higher at 24 months comparative to 12 months, regardless of QoL measure used. CONCLUSION:Our systematic review demonstrated a consistent pattern that moving to the community was associated with improved QoL compared with the institution. It is recommended that gaps in the evidence base, for example, with regard to growing populations of older people with intellectual disability and complex needs are addressed. PROSPERO REGISTRATION NUMBER:CRD42018077406.

SUBMITTER: McCarron M

PROVIDER: S-EPMC6502057 | biostudies-literature | 2019 Apr

REPOSITORIES: biostudies-literature

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Effect of deinstitutionalisation on quality of life for adults with intellectual disabilities: a systematic review.

McCarron Mary M Lombard-Vance Richard R Murphy Esther E May Peter P Webb Naoise N Sheaf Greg G McCallion Philip P Stancliffe Roger R Normand Charles C Smith Valerie V O'Donovan Mary-Ann MA

BMJ open 20190425 4

<h4>Objective</h4>To review systematically the evidence on how deinstitutionalisation affects quality of life (QoL) for adults with intellectual disabilities.<h4>Design</h4>Systematic review.<h4>Population</h4>Adults (aged 18 years and over) with intellectual disabilities.<h4>Interventions</h4>A move from residential to community setting.<h4>Primary and secondary outcome measures</h4>Studies were eligible if evaluating effect on QoL or life quality, as defined by study authors.<h4>Search</h4>We ...[more]

PMID: 31028039

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Project description:Individuals with disabilities are regarded as a highly vulnerable population group, particularly as far as oral health is concern. However, few studies have assessed the impact of the oral condition on the quality of life of these individuals. Therefore, the aim of this study is to expand knowledge on the oral health status of the Portuguese adults with mild intellectual disability, and to assess how the patient's oral health is related to their quality of life. A sample of 240 adults with mild intellectual disabilities linked to the Portuguese Federation for Intellectual Disability, were interviewed using a previously validated version of the Oral Health Impact Profile. An oral health examination was also conducted using three oral health indexes: Clinical Oral Health Index (COHI); Clinical Oral Care Needs Index (COCNI) and the Clinical Oral Prevention Index (COPI). Sociodemographic characteristics and dental health factors were also collected, following statistical analysis. More than half of the individuals (54,9%) presented one or more problems of major to severe impact on health (COHI level 2); only 4,6% of the individuals do not need treatment or examination (COCNI level 0) and 85% of the study sample needs measures of educational or preventive action (COPI level 1). In 76,9% of the participants, oral health had impact on the quality of life. The most affected dimensions of life were physical pain with 61,9%, followed by psychological discomfort and psychological disability with 45,1% and 45%, respectively. With relation to oral health factors and sociodemographic variables it was verified that fewer teeth and higher self-perception of need for dental treatment had a negative impact on the quality of life. On the other hand, institutionalization and an increase in at least one category in the self-perception of the oral health status had a positive impact on the quality of life. Given the high burden of oral disease and the considerable impact on quality of life found in this study, the establishment of guidelines to improve the oral health and quality of life of these individuals should be regarded as imperative.

Project description:ObjectiveMental health problems are more prevalent in people with than without intellectual disabilities, yet treatment options have received little attention. The aim of this study was to identify and evaluate the effectiveness of pharmacological and psychological interventions in the treatment of mental health problems in children and adults with severe and profound intellectual disabilities, given their difficulties in accessing standard mental health interventions, particularly talking therapies, and difficulties reporting drug side effects.DesignA systematic review using electronic searches of PsycINFO, PsycTESTS, EMBASE, MEDLINE, CINAHL, ERIC, ASSIA, Science Citation Index, Social Science Citation Index and CENTRAL was conducted to identify eligible intervention studies. Study selection, data extraction and quality appraisal were performed by two independent reviewers.ParticipantsStudy samples included at least 70% children and/or adults with severe or profound intellectual disabilities or reported the outcomes of this subpopulation separate from participants with other levels of intellectual disabilities.InterventionsEligible intervention studies evaluated a psychological or pharmacological intervention using a control condition or pre-post design.OutcomesSymptom severity, frequency or other quantitative dimension (e.g., impact), as assessed with standardised measures of mental health problems.ResultsWe retrieved 41 232 records, reviewed 573 full-text articles and identified five studies eligible for inclusion: three studies evaluating pharmacological interventions, and two studies evaluating psychological interventions. Study designs ranged from double-blind placebo controlled crossover trials to single-case experimental reversal designs. Quality appraisals of this very limited literature base revealed good experimental control, poor reporting standards and a lack of follow-up data.ConclusionsMental ill health requires vigorous treatment, yet the current evidence base is too limited to identify with precision effective treatments specifically for children or adults with severe and profound intellectual disabilities. Clinicians therefore must work on the basis of general population evidence, while researchers work to generate more precise evidence for people with severe and profound intellectual disabilities.Prospero registration numberCRD 42015024469.

Dataset Information

Effect of deinstitutionalisation on quality of life for adults with intellectual disabilities: a systematic review.

Publications

Effect of deinstitutionalisation on quality of life for adults with intellectual disabilities: a systematic review.

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