Health and Quality of Life
The general health of adults with CP is self-reported as good or satisfactory to excellent (59,60), and this can be comparable to that of the community at large (34). In a population-based study of adults with CP in a mid-sized
TABLE 21.2 AGING HEALTH AND PERFORMANCE CHANGES
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COMMON RELATED HEALTH CONDITIONS |
PREVENTION STRATEGIES |
TREATMENT STRATEGIES |
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|
Pain Fatigue |
Routine exercise Monitor and query routinely Work simplification Ergonomic evaluations Energy conservation |
Exercise prescription Query/evaluate sleep; manage as needed Evaluate for pain etiology and treat Modify equipment or workplace Evaluate mental health and manage Progress to pain management program |
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Musculoskeletal Contractures Hip pathology Knee pathology Foot or ankle pain Back pain |
Monitor and query routinely Joint protection strategies Routine exercise Biomechanic and ergonomic assessments |
Focal musculoskeletal evaluation Tone management Modify equipment, workplace, biomechanics of function Therapy prescription Adjust orthoses and wheelchair |
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Bone health Osteoporosis Fractures |
Routine exercise, especially weight-bearing Calcium/vitamin D supplement Fracture and fall prevention; education |
DXA evaluation Consider treatment when multiple fractures Exercise when appropriate |
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Neurologic Spasticity Seizures Spinal stenosis Nerve entrapments |
Routine monitoring Adjust medications with reported change Query for changes—high index of suspicion for pathology |
Tone management—medications, botulinum toxin injections, intrathecal baclofen Seizure management Radiological evaluation Electrodiagnosis Surgical referral when appropriate |
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|
Genito/urinary conditions Incontinence UTIs |
Monitor and query routinely Routine gynecologic follow-up for women and follow-up for men |
Urodynamic evaluation Scans/radiographs Medications and CIC when needed Urology referral as appropriate |
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Cardiovascular health |
Monitor blood pressure and typical serum panels Query for risk factors |
Treat cardiovascular symptoms and events |
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Obesity/overweight |
Healthy nutrition and weight management Measurement of body fat—consider waist circumference, DXA, or BIA Monitor for metabolic syndrome symptoms/signs |
Manage weight; promote exercise |
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Respiratory conditions Infection Sleep apnea |
Routine monitoring Immunization Query sleep hygiene |
Scoliosis evaluation Sleep study and management Specialty referral as needed |
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Gastrointestinal Constipation GERD Obstruction Oral motor problems |
Monitor and query routinely—recognition of severity Nutritional management Dental monitoring, preventive care |
Adjustment to bowel program regimen Specialty referral when appropriate Dental treatment Drooling management, including botulinum toxin injections and possible ENT referral |
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|
Deconditioning Falls |
Query about changes in function Routine exercise Education and prevention |
Therapy prescription—focus on strength and aerobics Reconsideration of equipment |
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Mental health |
Routine monitoring, especially for depressive or anxiety symptoms Query support, living arrangements |
Specialty referral as appropriate Referral for psychological and social support Use of community resources |
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Sexual functioning Fertility/reproduction Interference spasticity or pain Emotional/body image |
Engage in discussion re: sexuality Provide education about sexuality and function—appropriate modality for cognition and function Assist with environmental modification for routine assessments as able Ensure pregnancy high-risk needs are met |
Following pregnancy, support may be needed in the home |
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Health maintenance |
Monitoring—see Table 21.9 |
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Abbreviations: BIA, bioelectric impedance analysis; CIC, clean intermittent catheterization; DXA, dual energy x-ray absorptiometry; ENT, Otolaryngologist; GERD, gastroesophageal reflux disease; UTI, urinary tract infection.
U.S. metropolitan area, persons with CP were generally healthy (based on clinical information and self-report), but noted worries and concerns about their health status and future (61). Self-perceived health ratings and life satisfaction may be related to the presence of pain or functional changes over time, but not to the severity of impairment (62-64). A cross-sectional study of youth and young adults with CP in Canada using standardized measures noted youth were somewhat more positive about their health than young adults, although QOL scores were similar. Severity of CP was a strong predictor of health and QOL. Similarities between the groups were notable suggesting self-reported health and QOL outcomes may remain relatively stable across the transition to adulthood (65). HRQOL also remains fairly stable over time for people with CP. As individuals with CP grow and mature, many changes take place in their psychosocial development, which accordingly changes their expectations and those of their caregivers, peers, and professionals. The functional effect of CP seems particularly predictive of physical HRQOL, whereas the associated ID may affect their HRQOL in social functioning (2).
Health outcomes are also evaluated by the use of medical services. Despite reports of good health, a Canadian publication notes adults with CP visited outpatient physicians 1.9 times more than age-matched peers. Annual hospitalization admission rates were 10.6 times higher for adults with CP compared to their peers (66). The presence of other medical conditions is associated with increased odds of hospital or emergency department (ED) use (67). Analysis of the Canadian Institute for Health Information notes epilepsy and pneumonia are the top two reasons for hospital admissions for youth and young adults, and for young adults only, mental illness is the third most common admission diagnosis (68). Additional adult diagnoses included lower gastrointestinal (GI) problems or constipation, malnutrition or dehydration, upper GI problems, and two unique problems seen in the adult group: fractures and urinary tract infections (UTIs). These represent conditions for surveillance in an adult population of people with CP.
