It is important to ensure that the health care needs of people with learning disabilities are properly met. They may find it more difficult to describe their symptoms, particularly if verbal communication is difficult or impossible. They can also have problems obtaining the right kind of health care, treatment and advice, including preventative screening and health promotion.
Like everyone in the UK, the main source of health care for people with learning disabilities is the general practitioner and other members of the primary care team. Most general practitioners have limited experience of patients with learning disabilities, although there is increasing recognition of the need for skills training in this area.
The following specific health problems are discussed below: sensory impairments (hearing loss and visual impairment); problems associated with physical disability; epilepsy and mental health.
Sensory impairments
One in three people with learning disabilities are likely to have problems with their sight or hearing, or both.
Problems with sight are more common amongst people with severe learning disabilities and people with Down’s syndrome. These often go unrecognised, even though it is possible to test people who cannot read or talk. Eyesight can often be improved by wearing spectacles, using low vision aids or having cataracts surgically corrected.
About forty per cent of people with learning disabilities have moderate or severe hearing loss. Hearing problems are particularly common among people with Down’s syndrome and occur more frequently as people grow older.
Better assessment and identification of sensory impairments could make a great difference to people’s quality of life. After testing, someone who has had difficulty communicating because they were not hearing properly, may turn out to have less serious learning disabilities than was thought to be the case.
As well as regular testing, people with learning disabilities need regular support and advice with changing the batteries in hearing aids, keep spectacles clean, and using whatever aids have been prescribed.
Physical disability
At least a fifth of people with learning disabilities have some degree of physical disability which can affect speech, mobility and life expectancy. Multi-disciplinary assessment and care can help reduce the effects of physical disability and improve quality of life.
Epilepsy
People with learning disabilities, have a much higher risk of developing epilepsy, particularly if they have severe learning disabilities. Surveys suggest that up to one third of people with learning disabilities may be affected.
People with epilepsy may injure themselves during seizures and also have associated problems such as sleep disturbance, mood changes; they may also self-harm. Regular assessment and appropriate treatment are therefore essential.
Medication is the main form of treatment, although it can be difficult to control the epilepsy and avoid side-effects such as over-sedation. Effective management of epilepsy can improve a person’s quality of life as well as that of their carers who may otherwise suffer from anxiety, depression and strain.
Mental health
People with learning disabilities may be more at risk of developing mental health problems than the general population. About 25 per cent of the total population are likely to have mental health difficulties at some point in their lives. This compares with an estimated 25-40 per cent of people with learning disabilities who experience more of the risk factors associated with mental ill-health such as adverse life events and lack of social support.
Some progress has been made in developing ways of assessing people with learning disabilities including semi-structured interviews and checklists. Guidance is available on assessing, diagnosing and treating mental health problems in people with learning disabilities, though there is very limited evidence about the best treatments.
Teaching relaxation and social skills may help people manage their anger or anxiety. Cognitive-behavioural approaches can also be useful in treating anxiety, depression and anger, and can help men who sexually offend. It has also been suggested that psychodynamic psychotherapy can help people who have behaviour problems, although there is sparse evidence about its effectiveness.
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