The patient who is suffering from modern intellectual disability develops autoimmune diseases like type 1 diabetes. The patient in this case study has developed type 1 diabetes. The incidence of type 2 diabetes is also evident due to increased obesity and insulin resistance. The person develops diabetes because of increased stress, anxiety, genetic impairment, decreased physical activity and obesity. The incidence of type 1 diabetes in Australia has increased from 19.8% to 23.4 per 100,000 (Hillege, Gallagher, & Evans, 2013) . The patient also expresses frustration with the therapeutic regimen of type 1 diabetes. The most intriguing difficulty during the life span is inconvenienced in monitoring blood sugar. The patient also struggles to adhere to the restrictions of diabetes. The routine administration of insulin makes the patient feel unpleasant. This patient tries to skip the routine administration of insulin. This was also reported in a study that patient face the unpleasant challenge of routine insulin administration (Schöpf, Kollndorfer, Pollak, Mueller, & Freiherr, 2015) . These health challenges have a negative impact
Case History Review 3 on patients’ health related quality of life and nurses are the key to manage such cases to improve the health related quality of life. Impact of health challenges on daily activities of life: The patient suffering from health challenges of Down syndrome, type 1 diabetes and modern intellectual disorders has strong feeling of loss regarding the social life, food and physical disability. By using the internationally recognized disability framework, the ICF model, the impact of health challenges and surrounding environment on the daily activities of life can be determined. In this case study the patient is living in community housing and these feelings of loss are more prominent. The patient expressed worry regarding his future and feel depressed. One of the study also reported a similar sense of loss in patients with diabetes and intellectual disability disorder, but the patients were well aware of managing their diabetes (MacRae et al., 2015) . The patient has Down syndrome and reported to face difficulty in actively participating in social gatherings held at the community home. The disease condition of the patient create restrictions in daily activities and social roles of patient. The physical environment also impacts the behavior of the patient. It is seen that social environment plays a significant role in improving the participation of patient with Down syndrome in the daily activities of life. The barrier to the participation in social gatherings due to the health challenges of condition is related to the physical environment. The patients’ ability to do something by his own will seems to be restricted and this physical barrier was leading to more severe depression and anxiety in patients and concerned about their future. One of the study conducted in Ireland, also reported similar barriers in patients with intellectual disability (Phadraig et al., 2014) .
Case History Review 4 From the social perspective, the attitude of others toward the patient with Down syndrome, modern intellectual disability and Diabetes also seems to a barrier in their daily activities. When the people don’t interact with the patient or increased social distance between older patients and their relatives also worsen the disorder and patient feel lost. One of the main
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