Daily Health Checklist

Adults with Down syndrome have the same basic health care needs as others and should receive the same age-appropriate preventive care. Immunization schedules are the same and screening for high blood pressure, heart disease, cancer and dental disease is no different. To maximize your physical health, you need to eat a balanced diet, exercise regularly, and get enough sleep, and don't forget to enjoy time with friends or a fun hobby.

Skin - A number of skin problems are very common.

• Seborrheic dermatitis or dry scalp many require anti-dandruff shampoos.
• Folliculitis or a infection of the hair follicles, but can be treated with an antibacterial soap.
• Dry skin is a problem seen frequently. Moisturizing soaps and lotions or body creams are the best treatment.
• Fungal infections of the skin and nails are also more common.
• Tinea Pedia, or athletes foot, is treated with good daily cleaning followed by thorough drying. Changing sock in the middle of the day to keep the feet dry may be necessary.

Eyes - Poor vision is a common problem just as it is in the general population.

• Cataracts are more common, along with thinning of the cornea. Both can be sight-threatening and need to be followed regularly.
• Blepharitis or inflammation of the eyelids can be treated effectively.

Hearing/Ears - Hearing loss is also more common in adults with Down syndrome.

• Ear wax or fluid behind the drum can be causes of reversible hearing loss. Care must be taken to safely remove wax from the ears.
• Inner ear problems which affect the ability to hear high pitched sounds, including many speech consonants are common.

Sinuses - Sinusitis or sinus infections can be common, but are readily treatable with antigiotics and decongestants.

Teeth and Gums - Gum disease is common but can be prevented by good brushing, flossing and regular dental evaluations.

Gastrointestinal - Constipation is fairly common but can usually be managed by increasing the fiber in the diet and drinking plenty of water.

Gynecologic - General gynecologic care includes daily care and evaluation in the physician's office. In the office, a slow, gentle approach is used. Modified exams can be done to get a pap smear if a patient is sexually active.

Thyroid - An annual blood test to screen for thyroid disorders is recommended. Hypothyroidism (underactive thyroid gland) occurs in approximately one-third of adults with Down syndrome. The symptoms of hypothyroidism include dry skin, constipation, weight gain, lethargy, depression, cold intolerance, coarsening of the voice, joint aches and muscle cramps. Since a number of these are common characteristics of people with Down syndrome, it can be difficult to diagnose hypothyroidism on the basis of clinical findings. In addition, hyperthyroidism (overactive thyroid) is more common in adults with Down syndrome than in the general population (although much less common than hypothyroidism).

Urinary - Incontinence of urine that starts in adulthood may be more common than in the general population. Urinary tract infections and nervous system disorders need to be considered.

Orthopedic - Atlantoaxial instability must be considered as part of an evaluation.

Neurologic - Alzheimer's disease is a frequent concern regarding people with Down syndrome as they age. There is a tendency for persons with Down syndrome to develop Alzheimer's disease at a younger age (40s or 50s). Most importantly, many other medical and psychological problems that are potentially reversible and that can mimic Alzheimer's should be checked. These include poor hearing, poor vision, hypothyroidism, brain tumors, vitamin B-12 deficiency and depression.

Do’s and Don’ts of Medication

• Most people can benefit from taking a vitamin supplement, usually in the form of a multivitamin caplet.
• In addition to the preventive measures discussed as part of a healthy lifestyle, there are several other recommendations to promote health. Immunizations are recommended for all adults. After receiving the usual immunizations of childhood, a diphtheria-tetanus booster is recommended every ten years.
• For persons older than 65 and for persons with certain chronic illnesses, an annual influenza (flu) shot is recommended as well as a pneumonia vaccine every seven years. Some investigators have recommended that adults with Down syndrome should receive the flu and pneumonia vaccines in their 50s instead of waiting until 65 because of their relatively weaker ability to fight infections.

  Down syndrome is not one of the conditions that requires a child or younger adult to receive these immunizations, however, those with associated health problems such as congenital heart disease or recurrent pneumonia should receive them. In addition, flu vaccine is recommended annually for people living in residential facilities.

• Hepatitis B immunization is recommended for residents of residential facilities. In addition, some studies have found that other adults with Down syndrome are at greater risk for getting hepatitis B, possibly in workshops or other settings.

  Although hepatitis B transmission is generally considered to occur through blood (blood transfusions, shared needles) and sexual activity, hepatitis B virus is actually shed in all body secretions. In any setting where regular contact with an infected person's secretions can occur or where hygiene may be limited, hepatitis B may be transmitted.

  Hepatitis B immunization is given in a three-shot series. The second and third doses are given one and six months after the first. A blood test (Hepatitis B surface antibody) should be drawn one to two months after the third dose to confirm the effectiveness of the vaccine in providing immunity.

Keeping in Shape

• Twenty to thirty minutes of aerobic exercise at least three days a week is recommended. Aerobic exercise includes such activities as walking, running, swimming, biking and cross country skiing. Prior to starting an exercise program, you should have a physical exam and health screen.
• Obesity is more common in persons with Down syndrome. A recent study found that people with Down syndrome have a lower metabolic rate than the general population.
• Choosing snacks such as fresh fruit or vegetables, and low fat foods such as popcorn or pretzels, are much better than sweets.

Community Resources

This section of the Denver Adult Down Syndrome Clinic website is currently under construction. Please send an email to info@denverdsclinic.org with any questions you may have.