Hospital care for people with learning disability

Abstract

This review is an educational piece about people with learning disability. We identify this group, present their healthcare needs, and highlight some of the difficulties they experience in accessing appropriate care. Finally we offer practical advice on how to improve care for this vulnerable group. IntroductionPeople with learning disability experience health inequalities and die younger than those without learning disability. They often have problems accessing timely and high-quality care and frequently report negative experiences of hospital care. Improving care for people with learning disability is a national priority and can be achieved through a combination of systems improvements and change in individual practice. DefinitionsLearning disability is a lifelong condition defined by three core criteria:  Significant impairment of intellectual functioning (measured by psychometric testing); and  Significant impairment of adaptive/social functioning; and  Onset within the developmental period (i.e. before the age of 18 years)The term learning disability is synonymous with intellectual disability, the former used in the UK clinical services, the latter used internationally and often preferred in research. Learning disability is still known officially as 'mental retardation' in the International Statistical Classification of Diseases (and coded within F70-F79), although this term has now fallen out of favour due to its negative connotations. It is important to distinguish learning disability from the broader, non-specific term of 'learning difficulties' which is often used in educational or social care settings to denote specific disorders of scholastic skill, such as dyslexia, that occur without global impairment in cognition. Up to 2% of the population has a learning disability, an estimated 1 million people in England alone .Learning disability exists on a gradient, from mild to profound, and is sub-categorised by intelligence quotient (IQ) score (table 1). Many people with mild learning disability are not formally diagnosed and not known to statutory services. Learning disability may be caused by a number of factors that affect cognitive development before or around the time of birth, or in childhood (table 2). In many cases the cause of the learning disability is not known. (Table 1 near here) ( Table 2 near here) Health needs of people with learning disabilityPeople with learning disability are at greater risk of a range of physical and mental health disorders than the general population and one in seven adults with learning disability rates their general health status as 'not good' (Emerson and Hatton, 2008). They experience higher rates of respiratory disease, gastrointestinal problems, endocrine disorders, epilepsy, and are more likely to be overweight or underweight compared with the non-learning disabled population (British Medical Association, 2014).People with learning disability are therefore very likely to be encountered by the hospital physician, regardless of speciality. Furthermore, ...

Experiences of adults with intellectual disabilities accessing acute hospital services: A systematic review of the international evidence

“…Although adults with intellectual disabilities often attempt to inform healthcare professionals about their specific care and support needs, the communication approaches and implementation of reasonable adjustments is not always evident or consistent due to inadequate patient information systems, limited awareness and understanding of health professionals and accountability, and resources (Castles et al, 2014;Harris & Sheehan, 2017;Iacono et al, 2014;Welyczko, 2018). This apparent indifference may also in part be due to a lack of specific disability awareness training and education (Tuffrey-Wijne, Tuffrey-Wijne, Goulding, Gordon, et al, 2014).…”

“…The factors effecting healthcare access and utilisation include, higher rates of and vulnerability to specific health conditions, increasing longevity and conditions associated with 'old age', collectively resulting in the increasing 'complexity' of health needs (Regulation & Quality Improvement Authority, 2018). In contrast with the typically developing, conditions leading to admission include injuries and falls, diabetes, respiratory problems, chest pains and epilepsy (Castles et al, 2014;Drozd & Clinch, 2016;Harris & Sheehan, 2017).…”

‘Love makes me feel good inside and my heart is fixed’: What adults with intellectual disabilities have to say about love and relationships

“…Previous research has highlighted that the negative views of significant others present barriers to adults with intellectual disabilities achieving their relationship goals (Lofgren‐Martenson, 2004; Rojas et al, 2016). The phenomenon of ‘diagnostic overshadowing’ which affects so many areas of life for people with intellectual disabilities, particularly health care (Harris & Sheehan, 2017) is also known to affect their sexuality and relationships. This means that their identity as a person with intellectual disabilities can get in the way of them establishing an identity as an autonomous adult with ordinary desires and relationship goals (Wilkinson et al, 2015).…”