Clinical Geriatrics

Introduction
Adults with developmental disabilities are becoming more commonplace in society, particularly those who have lived with a disability their entire lives. Survival rates have vastly improved for children with chronic disabilities affecting physical function, such as cerebral palsy (CP)1 and spina bifida (SB).2 Current predictions suggest that many individuals with developmental disabilities will live into adulthood and age much like the general population; however, little is known about the natural history of these disorders over the lifespan.1 Since they are surviving longer, it is expected that many will require the services of a geriatrician and, in fact, the clinical practitioner may be the first link to healthcare these individuals experience as aging adults. It is important that clinicians become increasingly knowledgeable about the unique needs of this population, and become efficient in their evaluation and management.
Performing a comprehensive screen for function and mobility could provide valuable information to the clinician and result in early recognition of mobility and functional deficits. Often, the presenting complaint is the focus of evaluations; however, questions about overall function and mobility of the individual over time may be overlooked, and the long-term effects of chronic disability may be missed. Additionally, patients may not report these changes that have taken place over time because they either assume that decreases in mobility and function are a “normal” part of aging, or they may not recognize the mobility and functional changes because they have taken place slowly over a long period of time.
Moreover, the patient who lives daily with a chronic disability may not know to report changes that have occurred slowly over time. They in fact may assume that decreased function is to be expected with their developmental disability. Addressing these issues early may prevent secondary conditions that lead to mobility or functional changes. The clinical practitioner who is knowledgeable about the factors and systems that are commonly affected by these chronic disabilities and the secondary changes that occur over time will be able to address dysfunction early and minimize or prevent some of the secondary effects that can occur. Early detection and treatment may also decrease overall healthcare costs, as deficits and complications can be costly.
Disability-Specific Factors
Pertinent information concerning the developmental disability may be specific to that particular disability and can reveal some clue as to further expectations. For example, in individuals diagnosed with CP, the specific type is important to note (spastic or athetoid, hemiplegic or quadriplegic).3 In SB, the spinal level of the lesion (usually thoracolumbar), history of hydrocephalus, or history of seizures is pertinent.3
Multiple factors are noted in the literature that can affect adults with CP and SB, and include mobility and functional independence, complications in multiple systems, previous surgical procedures, and referral for rehabilitation services (Table I).1,4,5
Multiple Systems Factors
According to the Centers for Disease Control and Prevention, a secondary disability is a health condition that is causally related to a primary disability; however, these are, at least to some degree, preventable and are not always a part of the natural history of the primary disability.6 Because the impaired musculoskeletal system is at risk for developing secondary health conditions that affect function and quality of life in these adults, it is important to understand which of these secondary conditions occur and how they occur.