Self-Injurious Behavior in Older Adults with Intellectual Disabilities

Improved life expectancy for people with intellectual disabilities (IDs), defined as significant limitation in intellectual functioning and adaptive behavior skills (American Psychiatric Association, 2000; Schalock et al., 2010), has resulted in greater numbers of individuals experiencing older age (Fisher & Kettl, 2005). In recent decades, the substantial increase in life expectancy for people with IDs has resulted in those with mild IDs (approximately 85 percent of the population with IDs) approaching near parity with the general population (Bittles et al., 2002). Even people with moderate or severe IDs who often have more medically complex conditions are now enjoying longevity into their mid-sixties or late fifties, respectively (Bittles et al., 2002). These developments result from progressive changes in institutional and residential settings, improvements in medical care, assistive technology, and public health programs (Fisher & Kettl, 2005; Long & Kavarian, 2008). The overall outcome is a substantially increased population of older adults with IDs, but knowledge of their specific age-related issues by professionals and researchers has lagged behind these changes (Perkins & Moran, 2010). Though older adults with IDs experience chronic health conditions similar to those of older adults without IDs (for example, diabetes), they are also predisposed to a higher prevalence of pre-existing and age-related health issues (Cooper, 1997a; Haverman et al., 2010; Krahn, Hammond, & Turner, 2006; World Health Organization [WHO], 2000). Aging with IDs increases the risk of visual and hearing impairments, thyroid abnormalities, cardiovascular disease, osteoporosis, and osteoarthritis, along with other chronic health issues (for example, poor dental health, obesity, epilepsy, skin conditions, and gastrointestinal problems) that occur with higher prevalence than in the general population (Cooper, 1997a; Haverman et al., 2010; Krahn et al., 2006; WHO, 2000). Other age-related risks are cognitive decline and dementia; diminished adaptive abilities; and late-onset mental health problems, such as affective disorders, anxiety disorders, and phobias (Matson, Cooper, Malone, & Moskow, 2008; Myrbakk & yon Tetzchner, 2008). In concert with the general population as well as increasing age, issues regarding work and retirement changes, loss and bereavement, and reduced social support can also occur. These issues can magnify in the population with IDs, who may require lifelong support (from formal and informal caregivers) to meet their daily living needs. Challenging or problem behaviors (that is, self-injurious behavior [S1B], aggression, and stereotypy) can often arise from mental health problems or as a result of medical morbidity, developmental difficulties, or socioenvironmental stressors (American Psychiatric Association, 2000; Davidson et al., 2003; Emerson, 1995; Hams, 2010). Self-injury in the population without IDs is viewed as a broad class of both suicidal and nonsuicidal SIBs (for example, skin cutting with a razor; Nock & Favazza, 2009). However, people with IDs exhibit stereotypic nonsuicidal self-injury (Nock & Favazza, 2009). Thus, researchers and clinicians alike consider the population with IDs who exhibit SIB to be very distinct from the population without IDs who exhibit SIB (Nock, 2010; Ristic, 2005; Schroeder, Oster-Granite, & Thompson, 2002). Despite the fact that SIB can appear at anytime across the life span, coupled with the increasingly greater numbers of older adults with IDs, there has been little consideration of age-related issues and risk factors of SIB. This article will first describe SIB in individuals with IDs, including a review of theories and general factors associated with its manifestation. Key issues and aging-related risks specifically relating to older adults with IDs (that is, physical and mental health issues, socio-environmental stressors, and negative life events) that may cause or result in self-injury are discussed. …