1. Prevalence of physical ill-health in a cohort of adults with learning disabilities in Scotland
Dr Deborah Kinnear, Professor Jill Morrison, Associate Professor Linda Allan, Mrs Angela Henderson,
Professor Sally-Ann Cooper
University of Glasgow, Institute of Health and Wellbeing
Introduction
People with learning disabilities have different health needs and experience greater health inequalities when compared to the general population. Gastro-oesophageal reflux disorder, sensory impairments, osteoporosis, dental disease, musculoskeletal problems, accidents, and nutritional problems are all thought to be much more commonly experienced in people with learning disabilities. However, most studies have been small scale, with selected age groups, particularly older people, or methodologically limited.
Methods
A large prospective, cohort study
The adult population (aged 16 years and over) of people with learning disabilities living within the geographical area of Greater Glasgow Health Board, Scotland, were identified and recruited
Each participant underwent a comprehensive health assessment by nurses and three general practitioners
Physical health conditions were recorded using International Statistical Classification of Diseases (ICD -10)
Project Aims
To report the physical health conditions of people with learning disabilities
Research Questions
1. What are the most prevalent physical health conditions?
2. What is the extent of multi-morbidity
(two or more conditions) for this cohort?
Sample
Sample size: 1,562 potential participants, 1,023 adults consented (65.5%)
Gender: 562 males (54.9%) and 461 females (45.1%)
Age: Mean age of 43.9 years (range 16–83)
Ethnicity: 96.4% white
Marital Status: 95.7% were single
Level of disability: 38.9% Mild (n=398), 24.2% Moderate (n=248), 18.9% Severe (n=193), 17.9% Profound (n=184)
Accommodation type: 38.1% live with family carer (n=390), 10% live independently (n=102), 45.7% live with paid support (n=467), 6.3% congregate setting (n=64)
Down syndrome:18.2% (n=186)
Results
2. What is the extent of multi-morbidity for this cohort?
1. What are the most prevalent physical health conditions?
Common physical health conditions:
Skin (e.g. eczema)
Gut (e.g. gastro oesophageal reflux disorder)
Endocrine (e.g. obesity)
Symptoms & Signs (e.g. ataxic/gait disorders)
Total physical health conditions (M=11.35, SD=4.8)
Males (M=10.7, SD=4.6)
Females (M=12.1, SD=4.9)
1,015 (99.2%) individuals with learning disabilities had at least one physical health condition, 1,010 (98.7%) had two or more
Conclusions
Almost all people with learning disabilities had multiple morbidities. This has considerable implications for clinical care, as:
Health services and health care pathways are typically designed around single conditions
Multiple morbidity results in polypharmacy
Health assessment is more complex in view of differential diagnosis
Treatment is more complex in view of disease-disease, drug-disease, and drug-drug interactions
People with learning disabilities require much longer health care appointments
References
De Winter, A.A. Jansen, H.M. Evenhuis (2011) Physical conditions and challenging behaviour in people with intellectual disability: A systematic review. Journal of Intellectual Disability Research, 55 (2011), pp. 675–698
Emerson, E., & Hatton, C. (2014). Health inequalities and People with Intellectual Disabilities. Cambridge University press, Cambridge.
Emerson, E., Baines, S., Allerton, L., Welsh, V. (2012) Health Inequalities and People with Learning Disabilities in the UK: tinyurl.com/healthinequalities2012
Robertson, J., Hatton, C., Baines, S. & Emerson, E. (2015). Systematic Reviews of the Health or Health care of People with Intellectual Disabilities: A Systematic Review to Identify Gaps in the Evidence Base. Journal of Applied Research in Intellectual Disabilities, 28,
Scottish Government (2013). The keys to life - Improving Quality of Life for People with Learning Disabilities, Scotland.