PRIMARY-CARE OF ADULTS WITH MENTAL-RETARDATION

BACKGROUND. There is a national trend to deinstitutionalize mentally r etarded adults, placing them in community residential settings, As a r esult, community-based primary care physicians will assume responsibil ity for their medical care, Primary care physicians may have uncertain ties regarding the medical care of this population. The purpose of thi s case series is to describe the medical care of a group of adults wit h mental retardation during their first year of community residence fo llowing deinstitutionalization, and to provide practical advice to fam ily physicians who care for these adults. METHODS. Medical diagnoses a nd medications at the time of deinstitutionalization of a series of 21 adults were abstracted from institutional records and transfer forms, Follow-up data were obtained from office medical records. RESULTS. In the first year following deinstitutionalization, each patient average d 6.6 office visits to a family physician, Newly identified major heal th impairments were: chronic persistent hepatitis due to hepatitis B, acid peptic disease, gastroesophageal reflux disease, dysphagia, prima ry degenerative dementia, absence seizures, bronchiectasis, and idiopa thic iridocyclitis. Significant changes in pharmacotherapy included co nsolidation of multidrug anticonvulsant regimens and discontinuance of psychotropics and laxatives. Health maintenance practices included he patitis B immunizations, cholesterol determinations, smoking cessation counseling, and calcium supplementation. CONCLUSIONS. Newly deinstitu tionalized patients require careful diagnostic and therapeutic reasses sment. Family physicians assuming their care need to look for conditio ns common in this population, including dysphagia, seizure disorders, chronic hepatitis B, and sensory impairments. Previously neglected hea lth maintenance practices need to be instituted, Pharmacotherapies, pa rticularly anticonvulsants, psychotropics, and laxatives, may be amena ble to dosage reduction or discontinuance.