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Mortality in persons with developmental disabilities after transfer into community care
D Strauss1, R Shavelle, A Baumeister
1Department of Statistics, University of California, Riverside 92521, USA. strauss@citrus.ucr.edu
American Journal of Mental Retardation : AJMR
|June 2, 1998
Summary
Deinstitutionalization for individuals with developmental disabilities in California led to a 51% increase in mortality rates. This highlights the critical need for improved community care and medical supervision.
Area of Science:
- Public Health
- Developmental Disabilities
- Health Services Research
Background:
- California has transitioned over 2,000 individuals with developmental disabilities from state institutions to community care.
- Concerns exist regarding the impact of deinstitutionalization on health outcomes, particularly mortality.
- Previous research has not comprehensively assessed mortality changes post-transfer.
Purpose of the Study:
- To investigate the association between deinstitutionalization and mortality rates among individuals with developmental disabilities in California.
- To compare mortality rates of individuals moved to community care with those remaining in institutions.
- To identify factors influencing mortality risk following community placement.
Main Methods:
- A cohort of 1,878 individuals with developmental disabilities who were transferred from state institutions since April 1993 was analyzed.
- Mortality rates of transferred individuals were compared to expected rates for comparable institutionalized populations.
- Risk-adjusted analyses were performed to account for potential confounding factors.
Main Results:
- Risk-adjusted mortality rates for individuals moved to community care were 51% higher than for institutionalized individuals (p < .05).
- Excluding cancer deaths, the increased mortality rate rose to 67%.
- The highest mortality risk was observed shortly after the move and among the most recently transferred individuals.
Conclusions:
- The deinstitutionalization process in California has been associated with a significant increase in mortality among individuals with developmental disabilities.
- There is a critical need to enhance the provision of continuous, consistent, and competent medical care and supervision within community settings.
- Policy and practice adjustments are necessary to mitigate the elevated mortality risks associated with community-based care for this vulnerable population.