Down syndrome was said to be the first intellectual disability syndrome and, at the same time, the most common form of genetic intellectual disability. People started to become aware of this syndrome when Esquirol (1845) wrote about it, although it was Down (1887) who first created an accurate description of the said syndrome (Scorza et al., 2011, p.719). It is one of the most common congenital chromosome anomaly, in which there happens to be “one extra copy of chromosome 21 in cells in the body” (Down Syndrome Ireland, 2013, p.3). This irregularity may thus, affect the physical and intellectual development of the patient, even during childhood or infancy, and then continues until adulthood. For adults with Down syndrome, they usually have reduced sizes of their hippocampus, corpus callosum, and entorhinal cortex, which continues to reduce with increasing age. This brings about some challenges in the cognitive/intellectual phase, so that most of patients suffering in Down syndrome also have dementia or other intellectual disabilities.
The case is centered on an adult man who is 45 years of age and having Down syndrome and moderate intellectual disability. He suffers from a chronic illness of type 2 diabetes mellitus, and lives in a community group home being staffed by a batch of support workers. He takes time to attend a disability-specific day program from Monday to Friday. Being a patient with Down syndrome, diabetes, and moderate intellectual disability, he tend to experience some difficulties, especially in terms of the cognitive/intellectual phase, their immune system, as well as the physical and communicative phase. Physically, a person with the Down syndrome has short, broad necks and a height that is usually less than those of others. Unlike others, they confront challenges in their health, as they have higher risk of developing congenital heart defects and hearing/sight problems, infections, thyroid disorder, respiratory problems, immune disorder, as well as an obstructed gastrointestinal tract.
Health Challenges Brought by Down Syndrome, Diabetes, and Intellectual Disability
Health challenges brought by Down syndrome
There are a number of health defects and challenges for a 45-year-old male adult suffering from Down syndrome. These defects are usually related to the immune system and those that relate to the intellect. This may include vision and hearing problems, diabetes, Alzheimer’s disease, ischemic heart disease, respiratory infections, cerebrovascular accidents, leukemia, as well as seizures (Ross & Olsen, 2014, p.715). In the same way that other normal individuals face their health challenges, people with the Down syndrome also experience difficulties in communication, and those relating to socio-economic condition. They may also experience insufficient community support from healthcare institutions, and may face challenges in terms of advocacy. What is dangerous for them however, are the effects of an undiagnosed pathology, especially in health conditions that should be treated early like diabetes, celiac disease, and thyroid abnormalities. There are more challenges that the 45-year-old male patient may face within the given context, as he lives in a community group home, where there are age-related problems and a constant turnover of nurses.
Health challenges brought by diabetes mellitus
There are other health defects and challenges that are being faced by the 45-year-old male patient, given that he suffers from diabetes. Patients like this 45-year-old man are at risk of suffering the same health problems as the population, whether or not they have Down syndrome. On the other hand, the health challenges that patients with diabetes mellitus usually face include retinopathy or the loss of vision, nephropathy that leads to renal failure, and peripheral neuropathy that leads to foot ulcers and amputations (American Diabetes Association, 2013, p.S67). Still, there are protective factors found in patients with the Down syndrome, such as myopia and lower blood pressure that are both beneficial for those who are at risk of developing Down syndrome. Their abnormalities in growth hormone secretion, as well as their responsiveness, may also be beneficial to their health, although there should also be lifestyle factors involved in the treatment of their health. This includes weight control and a low glycemic factor diet, smoking abstinence, and exercise. In worse cases, insulin and oral hypoglycaemic agents may also be effective in the treatment of diabetes mellitus.
Health challenges brought by intellectual disability
Lastly, there are a number of health defects and challenges faced by a 45-year-old male patient suffering from intellectual disability and the Down syndrome. They usually have high rates of severe psychiatric ailments like mood, bipolar, psychosis, and some impulse control disorders (Dykens et al., 2015, p.5). Although they may not have psychotic symptoms, those with Down syndrome may experience auditory hallucinations and depression, as seen in the study that Urv et al. (2010) conducted. Dykens et al. (2015, p.5) mentioned this study of Urv et al. (2010) when they stated how 79 percent of those who were over the age of 50, experienced delusions or hallucinations. With this, the challenges may include blurring of “what is real versus pretend, having fantasies or imaginary friends, and engaging in overly concrete or magical thinking” (Dykens et al., 2015, p.5). They tend to mumble at any given time, as proven by the study that Glenn & Cunningham (year) conducted, wherein they found that 91 percent of the 77 young adults suffering from Down syndrome had experienced talking to themselves (Dykens et al., 2015, p.5).
The Effect of Activity and Participation Using the ICF Model
Functioning and disability
For adults suffering from Down syndrome, they usually have short broad necks, and hands that are broader and shorter, which have a lot to say on the type of activities that they tend to join. They also have low muscle tones or hypotonia, although it may improve over some time, and which would affect their physical activities and their rate of participation with the public. More so, their average height appears to be less than that of others, which may choose the type of activities and sports that they may be able to do. They also have slow metabolism and so, may tend to put on extra weight, which would also affect their manner of relating with other people, and how they feel about themselves. Still, they are like the normal people in the way they move, talk, feel, and act. The difference is only physical.
Contextual factors
Adults who suffer from Down syndrome have a tendency to experience slow learning, since it affects the cognitive/intellectual state of the patient, in which they learn at a much slower rate. For this, they may have difficulties when it comes to learning new things or new ways, and remembering what they learned for some time. They are also at a risk of experiencing problems in social interaction. This means that they should live within a context wherein people are friendly to them, and they are being cared for and be given all their needs. They should engage in social interaction by learning to love themselves, in spite of their condition. In spite of their difficulties in hearing and vision, they can counteract this by being surrounded by people who support them in all ways possible. They should live in an environment where they are able to live and interact freely with others in the community.
Intervention for Managing Diabetes
Many researchers try to find ways for managing type 2 diabetes mellitus in adults. Malkawi (2012), in his article, talked about useful prevention interventions for diabetes used in countries like the United States, UK, Australia, India, Netherlands, China, and Brazil. In this review, Malkawi (2012) found reliable evidence suggesting the effectiveness of physical activity interventions to prevent the occurrence of type 2 diabetes mellitus. They were also proven to be most effective in restoring plasma glucose and reducing diabetes frequency (Malkawi, 2012, p.5). This is the Diabetes Intervention Program, which makes use of well-trained health educators and exercise equipment that should be purchased. However, the outcome is really advantageous, since it will reduce the body mass index, improve the blood pressure, prevent illnesses and diseases, and improve health and lifestyle. It is evident therefore, how important the Diabetes Intervention Program is, as it includes both physical activity and diet, which control the production of glucose. Meanwhile, this intervention can be applied within the community by writing a review on the advantages of this intervention. Nurses can help by doing this report, so it can be implemented by those in authority.
Conclusion
For a 45-year-old man suffering from Down syndrome, diabetes, and intellectual disability, the world may have appeared to be dull and adverse. It is good that he attends a disability-specific day program from Monday to Friday, for him to feel positive—loved and cared for by others, such as those within the community group home. Nurses, however, carry the role of being able to support other patients, such as this man. As a nurse, they are supposed to be there whenever their patients are experiencing difficulty, either physically, emotionally, or psycho-socially. Thus, they should give all their support by telling others possible prevention interventions that can be applied for them to live in a better world.
References:
American Diabetes Association. (2013, January). Diagnosis and classification of diabetes mellitus. Diabetes Care, 36(1), S67-S74. doi: 10.2337/dc13-S067
Down Syndrome Ireland. (2013). Student information booklet. Retrieved August 20, 2016 from http://downsyndrome.ie/wp-content/uploads/2013/12/DSI_StudentPack_Home.pdf.
Dykens, E.M., Shah, B., Davis, B., Baker, C., Fife, T., & Fitzpatrick, J. (2015). Psychiatric disorders in adolescents and young adults with Down syndrome and other intellectual disabilities. Journal of Neurodevelopmental Disorders, 7(9), 1-8. doi: 10.1186/s11689-015-9101-1
Malkawi, A.M. (2012, June). The effectiveness of physical activity in preventing type 2 diabetes in high risk individuals using well-structured interventions: a systematic review. Journal of Diabetology, 2(1), 1-18. Retrieved August 20, 2016 from http://www.journalofdiabetology.org/Pages/Releases/PDFFiles/EIGHTISSUE/RA-1-JOD-12-002.pdf.
Ross, W.T., & Olsen, M. (2014). Care of the adult patient with Down syndrome. Southern Medical Journal, 107(11), 715-721.
Scorva, C.A., Scorza, F.A., Arida, R.M., & Cavalheiro, E.A. (2011). Sudden unexpected death in people with Down syndrome and epilepsy: another piece in this complicated puzzle. Clinics, 66(5), 719-720. doi: 10.1590/A1807-59322011000500001
Urv, T.K., Zigman, W.B., & Silverman, W. (2010). Psychiatric symptoms in adults with Down syndrome and Alzheimer’s disease. Journal of Intellectual Development Disability, 115(1), 265-276.
Wallace, R.A., & Dalton, A.J. (2006). Clinicians’ guide to physical health problems of older adults with Down syndrome. Journal on Developmental Disabilities, 12(1), 1-35. Retrieved August 20, 2016 from http://www.oadd.org/publications/journal/issues/vol12no1supp/DS_supplement_1.pdf
World Health Organization. (2013, October). How to use the ICF: a practical manual. Geneva: World Health Organization. Print.
