Learning Disability What does it mean?

Prenatal – chromosome, genetics, toxins Perinatal – birth complications, infections Post natal – infections or trauma Remember, LD cause must have started before adulthood

Prevalence of Learning Disability National Prevalence of people with a learning disability is estimated at 2 – 3% of the general population for all types of learning disability. 210,000 with severe or profound LD - 65,000 children - 120,000 adults of working age - 25,000 older people Mild to moderate LD 25 per 1,000 population (1.2 million) Per GP practice of 2,000 patients – average of 40 people with a learning disability Valuing People (2001)

Mild Learning Disability People with a mild learning disability are able to hold a conversation but may not recall details of a GP consultation May be independent in aspects of social care; they may live on their own without any paid support Basic or limited reading and writing skills Able to maintain social relationships and employment For these people, primary care teams will provide much of their health care with little need for intervention from specialist teams

Moderate Learning Disability These people enjoy a level of independence requiring additional support in some aspects of life; they may live in a supported living home or with carers/paid carers Be able to hold limited conversations with prompts Need assistance with social care Very limited or no reading and writing skills Able to enjoy social relationships and employment with support These people may be referred to specialist learning disabilities teams for additional support with health related matters

Severe or Profound Learning Disability These people are more likely to require a greater level of support in most or all aspects of life but with appropriate support will be able to enjoy a varied life and live in their own home which will be with paid carers or a shared home environment (residential or supported living) Very limited or specialised communication skills May have additional physical and mobility problems These people will commonly be known to the specialist learning disabilities teams for additional support in meeting health needs

Learning Disability is NOT… Problems with reading, writing or numeracy only i.e. Dyslexia, Dyspraxia Emotional and behavioural difficulties Attention Deficit Hyperactivity Disorder (A.D.H.D) or hyperactive disorder alone Asperger’s syndrome and some individuals with Autism However you can have a learning difficulty as well as a learning disability

There may be a relationship between: - learning disabilities - autism - learning difficulties - mental health but they can also be separate conditions Learning Disability Mental Health problems Learning Difficulties Autism

Diagnostic Overshadowing Described as: the presenting symptoms put down to a ‘learning disability’ rather than seeking another, potentially treatable cause When a person presents with a new behaviour or existing ones escalate, you should consider: Physical problems Psychiatric causes Social cause

Health Issues for people with Learning Disability Coronary Heart Disease – 2nd most common cause of death in LD – nearly 50% of people with Down’s Syndrome have congenital heart defects. Respiratory Disease – Most common cause of death – rates 3 times higher than the UK general population at 46 – 52%. Epilepsy – for 22% of the LD population it’s over 20 times more common than in the general population (=1%). Long term use of anti-epilepsy medication associated with loss of bone density Pain medication post seizure Sudden Unexplained Death in Epilepsy – 5 times more common for people with LD than in others with epilepsy Hollins S, Attard M T, von Fraunhofer N, McGuigan S and Sedgwick P (1998): Mortality in people with learning disability: Risks, causes and death certificate findings in London. Developmental Medicine and Child Neurology, 40:127 – 132. DOH 1998/ Valuing People 2001

Health Issues for people with Learning Disability Dementia – rates are 4 times greater with an early onset for adults with Down’s Syndrome Dementia care pathway for adults with learning disabilities Recommendation of screening for all adults with Down’s Syndrome over 30 Health check by GP / blood tests required to access memory clinic

Health Issues for people with Learning Disability Mortality – People with learning disability are 58 times more likely to die before the age of 50 Cancer – The pattern of cancer is different in people with learning disability with lower rates of lung, prostate and urinary tract cancers and higher rates of oesophageal, stomach and gall bladder cancer and leukaemia Helicobacter Pylori Infection – endemic for people with learning disability – postulated that high prevalence of this infection leads to a higher incidence of gastric carcinoma Healthcare for All, (2008) Treat me Right(2008)

Health Issues for people with learning disability Mental Health – Schizophrenia is 3 times more common for people with learning disability. Poor dental care & hygiene-80% of adults with Down’s Syndrome & 36.5% of other adults have unhealthy teeth & gums. Sensory Impairments – 30% have significant impairment of sight, 40% are hearing impaired. Healthcare For All(2008) Treat Me Right (2008).

Health Issues for people with learning disability Osteoporosis – People with a learning disability tend to have Osteoporosis younger & have substantially less bone density than in the general population, particularly those who are non weight bearing – Good Postural care is important (www.posturalcareskills.com)

Direct Enhanced Services – Annual Health Check for people with learning disabilities The provision of a Health Check for people with a learning disability is provided by way of a Directed Enhanced Service. While the health authorities must make this service specification available to all practices in Kent, as with all enhanced services, whether local or national, it is entirely up to individual practices to decide whether they want to offer it to their patients. Unfortunately, this not being provided is often a barrier for the people we support in receiving good, timely health care. Rosemary

Annual Health Checks

What to expect from a good Health Check General health issues Syndrome specific Genito-urinary issues Chronic illness Behavioural disturbances Cardio/respiratory health Vision/hearing Developed Health Action Plan

Health Action Plans The DES recommends the health check is integrated with the patients personal health record or health action plan A health action plan is a list of actions for the patient with learning disability and their carers to carry out within an agreed period. e.g. weight loss, medication management If further support is needed after this, the individual may be referred to the community learning disability team

The Learning Disability Team Speech and Language Therapy Physiotherapy Community Nursing Occupational Therapy KCC Care Management/ Social Work Administration and team Support Psychology Psychiatry Sensory

What the Team does Provides health interventions, specialist therapies, manage care Liaise with family, carers and other health professionals Shares expertise including training, advice and practical support