Rate of deficit accumulation in home care users with intellectual and developmental disabilities

Purpose: To identify factors associated with the rate of deficit accumulation in a population of adults with intellectual and developmental disabilities (IDD). Methods: A longitudinal analysis of administratively held clinical data collected at routine home care assessments across Ontario (Canada) using the Resident Assessment Instrument for Home Care (RAI-HC) was conducted using a cohort comprised of 5074 adults with IDD 18-99 years of age who had at least two home care assessments between April 1, 2003 and March 31, 2015. Rates of deficit accumulation were calculated across variables of interest. Incidence rate ratios and 95% confidence intervals are presented. Negative binomial regression models using a generalized estimating equation (GEE) approach were developed. Results: Increasing age, Down syndrome, and living in a group home were significant predictors of deficit accumulation. Rates of deficit accumulation tended to be higher among prefrail and frail individuals; however, impaired cognition and impairment in activities of daily living were associated with slower deficit accumulation. The relationship between provision of nursing and therapy services and deficit accumulation is unclear. Conclusions: Frailty should be monitored among adults with IDD starting at age 40 years, those with Down syndrome, and those who live in group homes. (C) 2018 Elsevier Inc. All rights reserved.