Note: Items that are indicated in bold italic are specific recommendations that differ from the Massachusetts Health Quality Partners (MHQP) recommendations in order to reflect particular health concerns of the population with mental retardation.
Health Maintenance Visit, including height and weight measurement
- 19-29 years: annually
- 30-39 years: annually
- 40-49 years: annually
- 50-64 years: annually
- 65+ years: annually
Breast Cancer: Mammography
- 19-39 years: Clinical breast exam and self-exam and self-exam instruction as appropriate. Mammography not routine except for patients at high risk. Accurate and detailed history and family history will identify risk factors.
- 40-49 years: Clinical breast exam and self-exam instruction as appropriate. Mammography every 1 to 2 years, at discretion of physician.
- 50-64 years: Clinical breast exam and self-exam instruction as appropriate. Annual mammography
- 65+ years: Mammography annually through age 69 years. Age 70 years and older, annually at the discretion of the physician.
Cervical Cancer: Pap Smear
- 19-64 years: Every 1 to 3 years, at physician's discretion
- 65+ years: May be omitted after age 65 if previous screenings were consistently normal
Colorectal Cancer
- 19-49 years: Not routine except for patients at high risk
- 50-65+ years: Fecal Occult Blood testing annually and sigmoidoscopy every 5 years OR colonoscopy every 10 years
Testicular and Prostate Cancer
- 19-39 years: Clinical testicular exam and self-exam instruction as appropriate. Prostate cancer screening not routine.
- 40-49 years: Not routine except for patients at high risk. Risk factors include: family history and African-American ancestry.
- 50-65+ years: At physician discretion after discussion of risks and benefits of available screening strategies (prostate specific antigen [PSA], digital rectal examination [DRE]).
Skin Cancer
- 19-65+ years: Periodic total skin exams targeting populations at high risk for malignant melanomas. Frequency at physician discretion.
Hypertension
- 19-65+ years: At least annually
Cholesterol
- 19-64 years: Every five years or at physician discretion
- 65+ years: at physician discretion
Diabetes (Type II)
- 19-65+ years: At least every 5 years until age 45. Every 3 years after age 45. Fasting plasma glucose screen for individuals at high risk. Risk factors include: family history of premature coronary heart disease (CHD), hypertension, diabetes mellitus, peripheral atherosclerosis or carotid artery disease, current cigarette smoking, or high-density lipoprotein (HDL) >35 mg/dL.
Liver Function
- 19-65+ years: Annually for hepatitis B carriers. At physician discretion after consideration of risk factors including long term prescription medication
Osteoporosis
- 19-64 years: Bone density screening when risk factors are present: long term polypharmacy, mobility impairments, hypothyroid, post-menopausal women. Periodicity of screening at physician discretion. Annually counsel about preventive measures including dietary calcium and vitamin D intake, weight-bearing exercise, and smoking cessation.
- 65+ years: Counsel elderly patients about specific measures to prevent falls.
Chlamydia and Sexually Transmitted Diseases (STDs)
- 19-29 years: For all sexually active males and females screen annually <25 years. >25 years screen annually if at risk.
- 30-65+ years: Annually if at risk. Risk factors include inconsistent use of barrier contraceptives, new or multiple sex partners in last 3 months, a new partner since last test, a history of STD, infected with another STD, and partner has had other sexual partner(s).
Human Immunodeficiency Virus (HIV)
- 19-65+ years: Periodic testing if at risk and testing of pregnant women at increased risk
Hepatitis B and C
- 19-65+ years: Periodic testing if risk factors present
Tuberculosis
- 19-65+ years: Tuberculin skin testing every 1 to 2 years when risk factors present. Risk factors include residents or employees of congregate setting, close contact with persons known or suspected to have tuberculosis (TB).
Hearing assessment
- 19-65+ years: Screen annually. Re-evaluate if hearing problem is reported or a change in behavior is noted.
Vision assessment
- 19-65+ years: Screen annually. Re-evaluate if vision problems are reported or a change in behavior is noted.
Eye Exam for Glaucoma
- 19-39 years: Every 3 to 5 years in high risk patients. At least once in patients with no risk factors.
- 40-64 years: every 2 to 4 years
- 65+ years: every 1 to 2 years
Depression
- 19-65+ years: Screen annually for sleep, appetite disturbance, weight loss, general agitation.
Dementia
- 19-39 years: Monitor for problems performing daily activities.
- 40-65+ years: In persons with Down Syndrome, annual screen after age 40.
Immunizations (as for the general adult population with the following exceptions)
- Influenza vaccine
19-65+ years: Annually
- Pneumococcal vaccine
19-65+ years: Once
- Hepatitis B vaccine
19-65+ years: Once. Reevaluate antibody status every 5 years.
For persons with Down Syndrome (in addition to the above recommendations)
- Thyroid function test
19-65+ years: Every 3 years (sensitive thyroid stimulating hormone [TSH])
- Cervical spine x-ray to rule out atlanto-axial instability
19-65+ years: Obtain baseline as adult. Recommend repeat if symptomatic, or 30 years from baseline.
- Echocardiogram
19-65+ years: Obtain baseline if no records of cardiac function are available.
General counseling and guidance
- Prevention counseling
19-65+ years: Annually counsel regarding prevention of accidents related to falls, fire/burns, choking.
- Abuse or neglect
19-65+ years: Annually monitor for behavioral signs of abuse and neglect.
- Preconception counseling
19-65+ years: As appropriate, including genetic counseling, folic acid supplementation, discussion of parenting capability.
- Healthy lifestyle
19-65+ years: Annually counsel regarding diet/nutrition, incorporating regular physical activity into daily routines, substance abuse.
General Counseling and Guidance Recommendations
Injury Prevention & Safety: Annually counsel caregivers to be alert to ways to prevent household injuries (fall prevention, choking prevention, fire/burn prevention).
Family Violence/Abuse: On all visits be alert to physical and behavioral signs and symptoms associated with abuse and neglect. Routinely ask all patients direct, specific questions about abuse including sexual abuse.
Preconception Counseling: Preconceptual counseling should include genetic counseling for hereditable conditions, assessment and discussion of parenting capability, as well as folic acid supplementation.
Menopause Management: Ages 40 – 50. Be alert to signs and symptoms of menopause; consider appropriate therapies to control symptoms.
Other testing considerations when individual has limited communication capacity.
For individuals who have significantly limited means of communicating their symptoms, screening labs (blood chemistries, complete blood count [CBC], perhaps TSH) should be considered at each annual health maintenance visit in order to supplement available information. Alternatively, in order to prevent unnecessary follow-up evaluations, it may be preferable to limit testing to the evaluation of specifically identified problems when a thorough and detailed history can be obtained from familiar caregivers.
Preparation for an examination
Many adults can be helped to feel more comfortable at a medical visit if they feel adequately prepared for the event. Family or support staff can be encouraged to introduce unfamiliar items such as a stethoscope or a blood pressure cuff at home to allow the instrument to become more familiar and facilitate cooperation during an exam.
During the exam, it is helpful to prepare patients for procedures by explaining them well or allowing patients with sensory impairments to explore the instruments that are about to be used. Performing simple examinations in an office or quiet waiting room may reduce a person's anxiety.
If someone is particularly anxious or an invasive screening procedure is necessary, the clinician might consider sedation prior to the appointment. In some cases, multiple procedures can be performed while the patient is sedated (dental work, or routine blood work, for example) to reduce the number of times a person is exposed to the risks of sedation.
Refer to Attachment D of the companion document "Preventive Health Standards Project FINAL REPORT," Center for Developmental Disabilities Evaluation and Research.
Communication
If a patient is unable to communicate regarding his or her own health status, clinicians may have to rely on a family member or support staff to provide information relating to signs or symptoms of health concerns. Questions regarding changes in the individual's behavior and adaptive function can bring underlying physical and mental health issues to light.
