1. Learning Disability What does it mean?

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

7. 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)

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

17. 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

18. 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

19. 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)

20. 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).

21. 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 (

22. 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

23. Annual Health Checks

24. 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

25. 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

29. 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

30. 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