Learning disabilities (health and wellbeing needs in South Tyneside)

 Health of people with a Learning Disability

Compared to the rest of the population, people with Learning Disabilities have:

• Lower life expectancy - people with Learning Disabilities have an increased risk of premature death compared to the general population. There is also a strong correlation between severity of Learning Disabilities and life expectancy (median life expectancies of 74.0, 67.6 and 58.6 for people with mild Learning Disabilities, moderate and severe Learning Disabilities). People with Down's syndrome have a shorter life expectancy than people with Learning Disabilities generally, though life expectancy in this group is increasing.
• Different causes of death - the main cause of death amongst people with a Learning Disability is respiratory disease (accounting for approximately half of all deaths and related to pneumonia and aspiration pneumonia), followed by cardiovascular disease (related to congenital heart disease rather than ischemia). This compares to cancer, heart disease and cerebrovascular disease being the leading causes of death in the general population. People with a Learning Disability are more likely to die from a preventable cause than the general population.
• Higher levels of unrecognised and unmet physical and mental health needs -People with are less likely to receive regular health checks than the general population. A recent study in Wales undertook health screening for 181 adults with Learning Disabilities. Over half the sample had health issues newly identified in the health checks, and 9% had health issues newly identified that were deemed to be serious, including breast cancer, suspected dementia, asthma, post-menstrual bleeding, diabetes, hypothyroidism, high blood pressure and haematuria.
• Barriers to accessing health services - people with Learning Disabilities often experience barriers in accessing health services, which will impact on medical treatment and management. Barriers can include problems with communication, inadequate facilities, rigid procedures, a lack of appropriate interpersonal skills among mainstream health professionals and a lack of accessible information. Uptake of screening amongst people with Learning Disabilities is lower than the general population (in South Tyneside proportion of the eligible population with Learning Disabilities that took up screening for the different cancers was as follows cervical - 7.32%, breast- 16.83% and bowel 23.23%) and people with Learning Disabilities are less likely to be immunized against tetanus, poliomyelitis and influenza than the general population.
• Different lifestyle issues - restrictions and a lack of opportunities to gain appropriate knowledge due to a lack of accessible health promotion services and materials may mean that adults with Learning Disabilities have limited understanding about health risks and consequently are unable to determine own healthy lifestyle choices. In general adults with Learning Disabilities;
  • have higher levels of obesity than the general population
  • are less likely to participate in the recommended levels of physical activity than the general population
  • are less likely to eat a healthy diet with an insufficient intake of fruit and vegetables than the general population

• Debate exists regarding the prevalence rates of alcohol 'use' and 'misuse' and with regards to illicit drug misuse amongst those with learning disabilities. Difficulties in establishing prevalence rates arise from the definition of 'learning disabilities', the methodology employed, levels of learning disability, and whether people are known to learning disability services or not. Generally evidence suggests lower prevalence rates in those with learning disabilities however the difference in prevalence decreases when looking at those with milder learning disabilities against the general population, and evidence does suggest a degree of underestimation and under identification - of both learning disability and substance use and misuse. Most of this unidentified learning disability population are hypothesised to be those with borderline to mild learning disabilities, living independently in the community, a sub-group of people who may be at greater risk of developing a substance related disorders.
• Adults with Learning Disabilities are more likely to experience epilepsy, gastro-oesophageal reflux disorder, sensory impairments, osteoporosis, schizophrenia, dementia, dysphagia, dental disease, musculoskeletal problems, accidents and nutritional problems than the general population. However, as the life expectancy of people with Learning Disabilities increases, the same age-related illnesses will also be experienced. For example the incidence of cancer amongst people with a Learning Disability is rising due to an increase in longevity.
• In addition, people with Learning Disabilities are more likely to be admitted to hospital as an emergency case, compared to those with no Learning Disability: - 50% of all admissions for those with Learning Disabilities are emergencies, compared to 31% of admissions in the general population in 2013 / 14. It is likely that this difference is due to problems in accessing care and lack of advance planning when people are transferred out of area.

Social issues for people with Learning Disabilities

People with Learning Disabilities do not just face challenges with healthcare. Many live in poverty and are unable to secure employment. National research suggests only 6.7% of people with a Learning Disabilities are in either part-time or full-time employment.

National research has shown many local authorities believe the type of housing people with Learning Disabilities and autism are in does not meet their needs.

National research also shows that people with Learning Disabilities are at increased risk of becoming victims of violence and abuse.

• The estimated proportion of people in prison who have Learning Disabilities or learning difficulties that interfere with their ability to cope with the criminal justice system is around 20-30%. Many are unidentified.
• Many people with Learning Disabilities have little or no contact with friends. National research study found that 31% of adults with a Learning Disability having no contact with friends, compared to 3% of adults without a Learning Disability.
• Six out of 10 women with Learning Disabilities who become a parent have their children taken in to care. Numbers of parents are small in each local authority however, they are likely to have complex and on-going support needs.
• Many people with Learning Disabilities are unable to travel independently and rely heavily on support to use public transport or the provision of adapted transport, often with a passenger assistant. Other issues identified for people with Learning Disabilities include employment and educational opportunities, hate crime, benefits changes as well as housing and support needs.
• Some people with Learning Disabilities display behaviour that challenges. 'Behaviour that challenges' is not a diagnosis and does not in itself imply any understanding as to the causes of the behaviour. The behaviour may be a way for someone to let people know what they want or how they feel, or to try and control what is going on around them, or be a response to physical or mental distress.
• A variety of factors are likely to contribute towards the development and escalation of behaviour that challenges, these include (but are not limited to): biological and genetic factors, physical ill-health, impaired communication difficulties, mental ill-health, the impact of poverty and social disadvantage, quality of support and exposure to adversities. Some care and support environments may increase the likelihood of behaviour that challenges, including those with limited opportunities for social interaction and meaningful occupation, lack of choice and sensory input or excessive noise, as well as environments where physical health needs and pain go unrecognised or are not managed.
• Behaviour that challenges can often result from the interaction between personal and environmental factors, and can include self-injury or physical aggression, severe agitation and extreme withdrawal, as well as behaviours that can result in contact with the criminal justice system - in some cases leading to someone being arrested, charged and convicted of an offence.
• Some people may have a long and persistent history of behaviour that challenges, perhaps starting in childhood. In others, it may be highly episodic - arising only under specific circumstances of stress or when the individual has a physical or mental health condition. In others still, it can be traced to a specific life event, such as bereavement. This means that even if someone does not display behaviour that challenges today, they may do so in the future.