title: Needs and challenges of daily life for people with Down syndrome residing in the city of Rome, Italy.
abstract: BACKGROUND
  Population-based surveys on the quality of life of people with Down syndrome (DS) are difficult to perform because of ethical and legal policies regarding privacy and confidential information, but they are essential for service planning. Little is known about the sample size and variability of quality of life of people with DS living in the city of Rome, which has a population of 2.7 million inhabitants. The aim of the present study is to explore the needs and challenges in health, social integration and daily life, of people with DS living in Rome.
  
  
  METHODS
  A cross-sectional, census-based survey was conducted in 2006. All family doctors (3016 in total) of the National Health Service were involved by the Statistical Bureau of the Municipality of Rome. As per the census, every resident citizen is registered with a family doctor and every person with disabilities is coded. Associations for Down Syndrome encouraged their members to participate in the research. Questionnaires were completed by families of people with DS, in accordance with privacy laws.
  
  
  RESULTS
  An initial survey, conducted via a letter and a telephone contact with family doctors, identified 884 people with DS residing in the city of Rome. Data on the medical and social conditions of 518 people with DS, ranging in age from 0 to 64 years, were collected. Some 88% of these were living with their original family; 82.1% had one or more siblings, and 19.5% had lost one or both parents. A full 100% of children with DS were enrolled in the public school system. This ensures that they are fully occupied and entirely integrated in society. After secondary school there is a lack of opportunities. Thus, only 10% of adults were working with a regular contract. A mere 42.2% of people with DS aged 25-30 were involved in some form of regular activity (although not always on a daily basis). After the age of 30, the percentage of people demonstrating decline in function increased sharply, while disability-related support decreased. In other words, as people with DS age, daily life evolves increasingly around the home, with only occasional outdoor activities.
  
  
  CONCLUSIONS
  The health, employment and social needs of the majority of people with DS in the city of Rome are not being met. The findings of this study underscore the urgent need for more comprehensive inclusion in society of adults with DS and for the provision of support services to create an enabling environment for inclusion. Because of the variability of performance among individuals with DS, there is a need to create more case-specific options in terms of work, living arrangements, social networking and medical services. Schooling and social inclusion in childhood alone do not guarantee a satisfactory quality of life in adulthood. It is argued herewith that policy of inclusion and support should extend over the entire lifetime of people with DS.
authors.affiliation: Genetica Medica, Ospedale San Pietro Fatebenefratelli, Roma, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Bertoli
authors.forename: G
authors.initials: G
authors.lastname: Biasini
authors.forename: M T
authors.initials: MT
authors.lastname: Calignano
authors.forename: G
authors.initials: G
authors.lastname: Celani
authors.forename: G
authors.initials: G
authors.lastname: De Grossi
authors.forename: M C
authors.initials: MC
authors.lastname: Digilio
authors.forename: C C
authors.initials: CC
authors.lastname: Fermariello
authors.forename: G
authors.initials: G
authors.lastname: Loffredo
authors.forename: F
authors.initials: F
authors.lastname: Luchino
authors.forename: A
authors.initials: A
authors.lastname: Marchese
authors.forename: S
authors.initials: S
authors.lastname: Mazotti
authors.forename: B
authors.initials: B
authors.lastname: Menghi
authors.forename: C
authors.initials: C
authors.lastname: Razzano
authors.forename: C
authors.initials: C
authors.lastname: Tiano
authors.forename: A
authors.initials: A
authors.lastname: Zambon Hobart
authors.forename: G
authors.initials: G
authors.lastname: Zampino
authors.forename: G
authors.initials: G
authors.lastname: Zuccalà
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D017028:Caregivers / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003156:Community Mental Health Services / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D004314:Down Syndrome / Q000523:psychology* / Q000534:rehabilitation*; D004495:Education of Persons with Intellectual Disabilities / Q000706:statistics & numerical data; D016832:Employment, Supported / Q000706:statistics & numerical data; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008607:Intellectual Disability / Q000523:psychology / Q000534:rehabilitation; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment / Q000706:statistics & numerical data*; D011788:Quality of Life / Q000523:psychology*; D012384:Rome; D017678:Sex Distribution; D012944:Social Support; D011795:Surveys and Questionnaires; D055815:Young Adult