Learning disability in the accident and emergency department

Abstract

Generally, people with learning disabilities now live in community settings and use generic health services. Those who develop behavioural or psychiatric disturbances may be taken to a hospital accident and emergency (A&E) department. An A&E visit can be the starting point of a comprehensive assessment of these disturbances. This article provides a framework for the initial assessment, management and disposition of patients with learning disabilities and behavioural disturbance presenting to an A&E department.

Emergency Department Visits and Use of Outpatient Physician Services by Adults with Developmental Disability and Psychiatric Disorder

“…They visit hospital EDs frequently, even though the ED is not an ideal environment for them. 7,25,26 As severity of psychiatric comorbidity increases, ED use cannot simply be attributed to poor access to either primary or psychiatric care. Rather, increased ED use among people with DD and concurrent psychiatric illness occurs despite reasonable access to primary care and specialty services, compared with access by people without DD.…”

“…3 These people access mental health services younger and more frequently than people with psychiatric disorders but no DD 4,5 and are frequent users of EDs. 6 It has been suggested that ED visits by people with psychiatric disorders with DD occur, in part, because other resources are inadequate 7,8 and thus serve as a barometer of the adequacy of primary and specialty outpatient care. A recent study found that lack of primary care predicted ED use in a sample of adults with DD experiencing psychiatric crisis, when adjusting for age, sex, residential setting, and disability severity.…”

Service Utilization Patterns in Parents of Youth and Adults With Intellectual Disability Who Experienced Behavioral Crisis

“…It has been well established that individuals with ID are at greater risk of developing physical and mental health problems or serious challenging behaviors compared with the general population (Cooper, Smiley, Morrison, Williamson, & Allan, 2007;Emerson & Hatton, 2007;van Shrojenstein Lantman-De Valk, Metsemakers, Haveman, & Crebolder, 2000). These health needs are often unrecognized and unmet (U.S. Department of Health and Social Services, 2002), which in turn can precipitate behavioral crisis (Bradley & Lofchy, 2005;P. W. Davidson et al, 1994;Lunsky, Gracey, & Gelfand, 2008).…”

Estimating the severity of intellectual disability in adults: A Mokken scaling analysis of the Learning Disability Screening Questionnaire.

“…The fact that these items appear to form a consistent hierarchy across individuals suggests that the additional difficulties experienced by people at risk of having an intellectual disability can be predicted from other reported difficulties. This should facilitate the optimal allocation of support and is likely to be helpful to professionals who do not have specialized knowledge of intellectual disability and to whom the individual is unknown but who have some indication of a person's support needs within contexts such as emergency admission to hospital (Bradley & Lofchy, 2005) Often, language difficulties and socially desirable responding can make obtaining accurate information about a person's functioning through self-report a challenge. Where full information on functioning is not available, scales with Mokken properties can be used to estimate that missing information on the basis of the information that is available.…”