| Issue |
Special Risks (s) |
Guidelines |
| Dental Health |
persons with developmental disabilities may have a much higher incidence of periodontal disease, oral mucosal pathology and moderate to severe malocclusion |
-establish appropriate dietary habits
-three month dental visits for those at risk and those with active oral disease
-six month prophylaxis for all
-preventive therapies such as fluoride should be used, as applicable
-use team approach for planning
|
| Vision |
persons with Down syndrome at risk for cataract after age 30 |
routine screening for age-related visual loss at 45 and every five years thereafter
-persons with Down syndrome should receive a check at age 30
|
| Hearing |
increased likelihood of ear wax |
-screening at age 45 and every five years thereafter
-persons with Down syndrome should be screened every three years throughout life
|
| Nutrition |
obesity and chronic constipation are prevalent; people with cerebral palsy are at higher risk for GERD (gastro-esophageal reflux disease) and dysphagia |
simple screening using tool for that purpose
-high risk individuals should be assessed by an experienced professional
-team approach to developing interventions
|
| Constipation |
higher risk for persons with limited mobility and for persons taking certain medications |
-dietary assessment and pro-active medical treatments |
| Epilepsy |
higher prevalence; high risk for physical trauma; impact of medication; social impact |
-seizure management plan
-annual medication assessment
-education for consumers and care givers
-special hazard warning for bathing and water
|
| Thyroid Disease |
behavior change may be observed as only symptom |
-persons with previous history or with Down syndrome should have thyroid function test performed annually; all others every three to five years
-possible medication supervision
|
| Mental Health |
may be limited availability of psychiatric services for this population |
-“Health services should implement strategies to maximize the quality of identification and management of mental disorders”. |
| Gastro-esophageal reflux disease (GERD) and Helicobacter pylori |
very high prevalence |
-identify and treat GERD and illness from Heliobacter pylori |
| Osteoperosis |
use of anticonvulsants; small body size; hypogonadism; Down syndrome; increased risk for fracture |
-early screening and prevention
-vitamin D supplement, as indicated
-bone mineral density assessment for post-menopausal women and men with hypogonadism
-prevention of falls
|
| Medication Review |
reviews may be inadequate; daily medications may be necessary; possible limited ability to consent and ability to monitor
|
-ideally, medication reviewed quarterly when polypharmacy exists
-consumer education
-systems for packaging for individuals living in the community
-structured methods for monitoring
|
| Immunization Status |
some data indicates less regular immunizations received than the general population
|
-follow national guidelines
-Hepatitis A & B immunizations for persons living in institutions; Hepatitis B for persons in contact with carriers
-influenza and pneumococcus immunization for medically vulnerable
|
| Physical Activity and Exercise |
immobility is a predictor for mortality; presence of cardiovascular risk factors |
-30 minutes or more of moderate intensity physical activity on most days
-provide daily active or passive movement for those with limited mobility
|
| Comprehensive Health Assessments |
support needed to access services; undetected health problems |
-regular, comprehensive physical assessment
|
| Genetics |
need for informed genetic counseling for family members; estimates up to 50% genetic etiology
|
-referral to genetic clinic unless diagnosis present
|
| Women's Health |
individualize screenings |
-Papanicolaou smears necessary; if sedation needed, balance against benefits
-mammograms as recommended for general population*
|
* Note: Readers of the web site may wish to obtain additional specific guidelines for women’s health at www.ACOG.org and www.AAFP.org.