Pain in Older Adults with Intellectual Disabilities
People with intellectual disabilities (ID) have both intellectual and adaptive deficits resulting from genetic or medical disorders. Although scientific and clinical awareness has emerged that atypical pain responses in ID do not necessarily reflect pain insensitivity or indifference, pain assessment is still hampered by the risk of incorrect interpretations. Older adults with ID form a complex subgroup, because challenges in pain management from general older adult care and care for people with ID are combined. An increasing life expectancy demands an expertise in palliative care for the ID population, with its central concepts of pain treatment, quality of life, and communication difficulties. Although some categories of behavior appear sensitive for pain in adults with ID and pain diagnostic instruments have been developed, an individual approach is needed due to the many factors that influence pain in the ID population. This includes a tailor-made pain management plan with pharmacological and non-pharmacological interventions targeted at the pain characteristics of the specific individual in context of medical and psycho-social co-morbidities.
KeywordsIntellectual disabilities Misconceptions Atypical pain behavior Communication difficulties Individual pain profiles Pain management plan Polypharmacy Analgesic failure
- Canning J, Bandyopadhyay S, Biswas P, Aslund M. Meeting the end of life needs of older adults with intellectual disabilities. In: Chang PE, editor. Contemporary and innovative practice in palliative care. Rijeka: InTech Published; 2012. p. 255–70.Google Scholar
- Doody O, Bailey ME. Interventions in pain management for persons with an intellectual disability. J Intellect Disabil. 2017a:174462951770867. https://doi.org/10.1177/1744629517708679.
- Kerr D, Cunningham C, Wilkinson H. Responding to the pain experiences of people with a learning difficulty and dementia. New York: Joseph Rowntree Foundation; 2006.Google Scholar
- Lotan M, Moe-Nilssen R, Ljunggren AE, Strand LI. Research in developmental disabilities measurement properties of the non-communicating adult pain checklist (NCAPC): a pain scale for adults with intellectual and developmental disabilities, scored in a clinical setting. Res Dev Disabil. 2010;31:367–75.CrossRefPubMedGoogle Scholar
- McCallion P, McCarron M. Ageing and intellectual disabilities: a review of recent literature. Curr Opin Psychiatry. 2004;17:349–52. https://doi.org/10.1097/01.yco.0000139968.14695.95.CrossRefGoogle Scholar
- Oberlander T, Symons F. Pain in children & adults with developmental disabilities. Baltimore: Paul H. Brooks Publishing Co; 2006.Google Scholar
- Sinnema M, Maaskant MA, van Schrojenstein Lantman-de Valk HMJ, Boer H, Curfs LMG, Schrander-Stumpel CTRM. The use of medical care and the prevalence of serious illness in an adult Prader-Willi syndrome cohort. Eur J Med Genet. 2013;56:397–403. https://doi.org/10.1016/j.ejmg.2013.05.011.CrossRefPubMedGoogle Scholar
- Solodiuk JC, Scott-Sutherland J, Meyers M, Myette B, Shusterman C, Karian VE, et al. Validation of the Individualized Numeric Rating Scale (INRS): a pain assessment tool for nonverbal children with intellectual disability. Pain. 2010;150:231–6. https://doi.org/10.1016/j.pain.2010.03.016.CrossRefPubMedPubMedCentralGoogle Scholar