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Physical aspects. Aim New referral General LD Weight Sensory Epilepsy Dental continence Special population Down syndrome Ongoing shared care.

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Presentation on theme: "Physical aspects. Aim New referral General LD Weight Sensory Epilepsy Dental continence Special population Down syndrome Ongoing shared care."— Presentation transcript:

1 Physical aspects

2 Aim New referral General LD Weight Sensory Epilepsy Dental continence Special population Down syndrome Ongoing shared care

3 Peter  55yr old man with Down’s syndrome  6 month h/o changed personality. Irritability.  Tearful, withdrawn.  Reduced mobility. Falls. Reduced self care.  Forgetting carer’s names  Sister wanted “total body scan”  Weight loss

4 MSE  Wheelchair  L sided weakness. Somnolent.  Depressed affect  Few words “terrible”  Nil psychotic  Cognition – unable to remember carers Place ok  Insight

5 What next?..... ?

6 New Referral Consider / rule out physical pathology Endocrine Infection Carcinoma Rarities !! Baseline ECG FBC, U & E (eGFR), LFT, RBS, TFT’s, lipid profile, prolactin level

7 General - Health Needs

8 General health needs… Popn with increased health needs Communication problems Reduced ability to identify & communicate Increased longevity > increased conditions eg carcinomas dementia

9 Healthcare for All 2008 Hollins et al 1998 58 x more likely to die before 50 1/3 LD associated morbidities puts at risk Postural deformities Chest infections Dysphagia Gastro-oesophageal reflux Constipation / incontinence Osteoporosis

10 Healthcare for All continued Hollins study Early deaths associated with Cerebral palsy Problems with mobility Residence in hospital Halstead (2000) Behavioural disturbance & disability better predictors of low volume poor quality care in primary care Mir 2004 Ethnicity & disability – adversely affected mortality

11 Healthcare for All continued Epilepsy 1/3 Epilepsy (20x > general population) Harder to treat  SUDEP NICE 2002 60% child deaths avoidable 40% adults avoidable

12 Healthcare for All continued Obesity  exercise Sensory impairments

13 Healthcare for All continued PEARL study 2002 181 people ½ new health need identified BM Hypertension Hypercholestrolaemia Thyroid disorder Dental Cardiac\asthma mental health

14 Healthcare for All continued Higher medical & dental interventions Lower surgical Similar admissions but shorter stays DM less BMI Stroke less BP

15 Healthcare for All continued Less likely pain relief Less likely palliative care

16 Healthcare for All continued Life less valued? Symptoms misinterpreted Diagnostic overshadowing Challenging Behaviour

17 Carers Ignored concerns – “Six lives” Excluded from consultation Expected to manage to much Carers Act 1995 - assessment of need

18 Weight Two ended cluster Obesity Additional morbidities Medication Physical disability Dependence on others for healthy lifestyle Food treat Less knowledge re healthy


20 Weight Office National Statistics 2001 19% males & 21 % females – obese 19.1 males with LD & 34.6% females with LD Females > males Community > institutions Mild Moderate LD> more severe  Importance carer cooperation

21 Weight Associated conditions Down’s Prader – Willi Carpenter Lawrence – Moon –Biedl Cohen

22 Underweight Malnutrition Feeding difficulties Fed by others Soft food Regurgitation Immobility More severe LD Choreo – athetoid movements Pressure areas **

23 Sensory Impairment Higher rates Detection – carers Professional testing Routine screening Hearing Middle ear infections Wax 7x

24 Hearing Middle ear infections Wax 7x Associated conditions Down’s Fragile X Noonen

25 Vision 1990 Aitchison > ½ adults in institution had eye problem Undetected Severe / profound more likely visual impairment Associations Down’s Prader – Willi Noonan

26 Epilepsy Common 14 - 44% cf ( 0.5 -%) Increased younger Increased severity LD More complex More polypharmacy Increased SUDEP

27 Dental disease High levels poor oral hygiene Studies > less restorative work Medication > periodontal probs phenytoin > gingivitis Associated Angelmans Fragile X

28 Incontinence Cooper (1998) 17.4% - 20-64 49.3% >64 Sensory impairment Mobility Infection / indication of morbidity Related to Behaviour

29 Respiratory disease ½ all deaths respiratory ( general popn 8%) Increased in more disabled cf Down’s more able die of respiratory infections Immobility Under weight

30 Heart disease Reduced Likely increasing ?impact of atypical AP High risk obesity

31 Heart disease Associated Downs Noonan – pulmonary stenosis, ASD, hypertrophic cardiomyopathy Prader –Willi syndrome – rhabdomyomata of heart & arrhythmias Fragile X (mitral valve prolapse)

32 Cancer Increasing with life expectancy GI tract more common. Breast prostate less

33 Barriers to healthcare Require more attention Receive same as gen pon Untreated conditions Low level heath promotion & screening Mobility probs Communication Cooperation Liaison with CLDT Health promotion work Support / assist access health

34 Annual Health Checks

35 “reasonable adjustment” health inequalities Reports Closing the Gap 2006 Death by indifference 2007 Independent inquiry into healthcare for people with learning disabilities “Healthcare for all” 2008 “six lives” 2009

36 Annual Health Checks Minimum standard Des specification All with LD known to SS >18 Mod/severe Mild + additional needs Vital signs annual data collection – who eligible – if received check Training

37 Annual Health Checks Training Understanding of LD Identification of people with LD & coding Understanding range & increased health needs Health check Information needed before health check Understanding health action plans Understanding & awareness of 1:1 health facilitation& strategic health facilitation

38 Training for health checks Overcoming barriers Communication Physical access Attitudes Accessible info & aids Values & attitudes Collaborative working Cares CLDT Social care supporters

39 Experiences & expectations Consent Disability Discrimination Act resources

40 Health check Review physical & mental health & referral as needed Health promotion Systems enquiry & review of chronic illness Physical exam Review of epilepsy Review of B & mental health Syndrome specific check Accuracy of prescribed medn Review of coordination with secondary care Review transition arrangements

41 Contacts CLDT 01422 363561 (ask for Julie Chadwick LD team.) Amanda McKie Complex Needs Matron Calderdale & Kirklees 07827084120

42 References Clinical directed enhances services (DESs) for GMS contract 2008/2009 Fraser, W. & Kerr, M. Seminars in the Psychiatry of Learning Disabilities 2 nd edition Butler & Meaney. Genetics of Developmental Disabilities Healthcare for All (2008) Six lives

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