Promoting Health, Supporting Inclusion

1. Promoting Health, Supporting Inclusion June Brown Nurse Consultant ~ Learning Disabilities Healthpoint May 2010

2. Aims • To define what a learning disability is • To explore the differing health needs of people with learning disabilities • To consider the health inequalities people with learning disabilities face • To explore how to reduce health inequalities for people with learning disabilities within NHS Grampian

3. Definition of Learning Disabilities • those with a significant, lifelong condition that started before adulthood, that affects the individuals development and means they need help to understand information, learn new skills and cope independently” Scottish Executive, 2000 • IQ less than 70 - ICD 10 Classification, 2003 • Tested by IQ and social adaptation assessment

4. Changing demographics • 120, 000 children and adults with intellectual disabilities in Scotland – few ever in hospital • Increasing learning disability subpopulation Projected 11% increase over next 10 years • Ageing learning disability subpopulation • Increasing number of people with complex learning disabilities • Health needs never historically addressed

5. Health Needs of Learning Disability Subpopulation • Have greater health needs than the general population • Patterns of health need differ than that of the general population • More likely to die before age of 50 • Leading causes of death differ • Have a greater variety and complexity of health problems

6. Causes of death 1. Cancer 2. Ischaemic heart disease 3. Stroke 1. Respiratory disease 2. Congenital heart disease 3. Cancer Types of malignancy Lung and bronchus Prostate Breast Oesophagus Stomach Gall bladder Causes of Death

7. Mental health • A different pattern of mental ill health from the general population • Dementia more prevalent • Schizophrenia common • Depression & anxiety disorder common • Lower levels of suicide • High levels of unmet need

8. Higher Prevalence of Certain Medical Conditions • Epilepsy - 22% of people with LD, compared to 1% • Dementia - 21.6% of people with LD, compared to 5.7% • Schizophrenia - 3% of people with LD, compared to 1% • Greater risk of thyroid problems • People with LD get osteoporosis earlier and more likely to have fractures • Hearing problems - 40% of LD population • Dental care - 36.5% of adults and 80% of people with Downs Syndrome have unhealthy gums and teeth • Weight problems - more likely to be either overweight or underweight • Mental health problems - one in three people have experience • Gastro-oesophageal reflux disease (GORD) - 48%

9. Barriers to Healthcare • Communication • Assumptions and attitudes • Physical barriers • Discrimination • Appointment systems • Gaining informed consent

10. Public Health Improvement • If we use findings from the general population what will happen? • This further widens the health inequality gap • Focus on factors of high relevance to the general population, not necessarily so for the population with learning disability • Omission of factors of high relevance for the population with learning disability

11. How do we close the gap? • Scotland’s solution is health promotion • Quit smoking • Fruit and vegetables; nutritional helpline • Special projects and resources for people in deprived areas • Road traffic accident projects • These solutions should work for people with the common Scottish health needs. ON their own they are inadequate for people with learning disabilities

12. The most significant challenges addressed Investment and development is necessary to enable health improvement for people with learning disabilities Areas of development in Grampian - • Equally Well Project • Keep Well • Primary Care • Acute Care

13. Equally Well Project • £450k for next 3 yrs • Meaningful engagement with service users and family carers • Health Inequalities project team to be established • Primary care resource toolkit • Accessible information- Signpost services, health improvement • Health promotion work with paid care workers • Health checks in prison care (research component) • Education tools (electronic)

14. Questions?

15. Further Reading BEANGE, H., et al. 1995. Medical disorders of adults with mental retardation: a population study. American Journal of Mental Retardation. 99, pp. 595-604. BAXTER, H., et al. 2006. Previously unidentified morbidity in patients with intellectual disability. British Journal of General Practices. 56, pp. 93-98. COOPER, S. A. et al., 2004. People with intellectual disabilities: their health needs differs and need to be recognized and met. British Medical Journal. 239, pp. 414-415. COOPER, S. A. et al., 2006. Improving the health of people with intellectual disabilities: outcomes of a health screening programme after one year. Journal of Intellectual Disability Research. 50 (9), pp. 667-677. ELLIOT, J. et al., 2003. The health of people with learning disabilities in the UK: evidence and implications for the NHS. Journal of Integrated Care. 11 (3), pp. 9-17. FERNANDO, L. et al., 2001. A study of physical health needs of people with learning disabilities living in the community. The British Journal of Developmental Disabilities. 47 (1), pp. 31-37. JANICKI, M. P. et al., 2002. Health characteristics and health services utilization in older adults with intellectual disabilities living in community residencies. Journal of Intellectual Disability Research. 46 (4), pp. 287-298. JENSEN, D. et al., 2004. People with intellectual disabilities and their health problems: a review of comparative studies. Journal of Intellectual Disability Research. 41 (5), pp. 409-415. MILLAR, G. R., and SCOTT, J., 1998. What is augmentative and alternative communication? An introduction. In: A. WILSON, ed. Augmentative Communication in Practice: An introduction. 2nd ed. Edinburgh: CALL Centre. MELVILLE, C. A. et al., 2008. The prevalence and determinants of obesity in adults with intellectual disability. Journal of Applied Research in Intellectual Disabilities. 21, pp. 425-437. NHS SCOTLAND, 2004. Health needs assessment report: people with learning disabilities in Scotland. Edinburgh: The Stationary Office. PATJA, K., 2000. Life expectancy of people with intellectual disabilities: a 35 year follow-up study. Journal of Intellectual Disability Research. 44, pp. 590-599. QUALITY IMPROVEMENT SCOTLAND, 2006. Promoting access to healthcare for people with a learning disability – a guide for frontline staff. Edinburgh: NHS Quality Improvement Scotland. SCOTTISH EXECUTIVE, 2000. The same as you?: a review of services for people with learning disabilities. Edinburgh: The Stationary Office. STRAETMANS, J. M. et al. 2007. Health problems of people with intellectual disabilities: impact for the general practice. British Journal of General Practice. 57, pp. 64-66. UNITED KINGDOM PARLIAMENT, 1995. Disability Discrimination Act. London: HMSO. VAN SCHROJENSTEIN LANTMAN-DE VALK, H. M. J., 2005. Health in people with intellectual disabilities: current knowledge and gaps in knowledge. Journal of Applied Research in Intellectual Disabilities. 18, pp. 325-333. WORLD HEALTH ORGANISATION, 2007. International classification of diseases-10. http://www.who.int/classifications/apps/icd/icd10online/. (Accessed on 12/12/08).