2. Definition of Learning Disability
Learning Disability (LD) is “a state of arrested or incomplete development of the mind, which includes significant impairment of intelligence and social functioning”.
It is the reduced ability to understand new or complex information and to cope independently.
This would have occurred before adulthood and has a lasting effect on development and has contributed to the overall level of intelligence, i.e cognitive, communication, motor and social abilities.
The level of disability varies greatly between one person and another and may or may not be accompanied by a physical disability.
Learning disability is usually defined in terms of IQ levels with an I.Q of 70 or less indicating learning disability / Intellectual disability
Dyslexia or any other educational difficulty, adult acquired head injury and cognitive decline due to psychosis are not learning disabilities.

3. Categories of learning disability
Mild LD
Most common, I.Q. Range from 50-69
Delayed processing and speech – able to use simple everyday speech
Full independence – personal care, practical and domestic tasks
Difficulties with reading and writing
Capacity to undertake unskilled or semi skilled work
Problems with social or emotional immaturity
Rarely organic aetiology.

4. Moderate LD
I.Q range 35-49
Limited comprehension and communication skills
Prompting or support with personal care
Can carry out simple practical tasks but may need support and guidance
Majority organic aetiology
Epilepsy and physical disability common

5. Profound and Multiple LD (PMLD)
I.Q less than 20 but difficult to measure, mental age of less than three years
Severe limitation in ability to understand or comply with requests or instructions
Little or no self care skills
Often require a modified diet and full assistance to eat and drink or have entral feeding
Often require continence aids
Often have little or no verbal communication, some people can sometimes use simple Maketon
Often have a severe physical disability
Palliative diagnosis

6. Number of adults with a learning disability known to local authorities per 1000 population (2017)
09/05/2019

7. Health Inequalities
National statistics estimate that approximately 5.2% of the national population has a learning disability with Dundee having the highest number of people with a LD known to Local Authority.
People with a LD have poorer health than the general population much of which is avoidable. Inequalities often start in early life as people with a LD face barriers in accessing timely, appropriate and effective health care.
People with a LD are 58 times more likely to die before the age of 50 than the general population.
Confidential inquires into premature deaths of people with a LD showed that they are 3 times as likely as people within the general population to have a death classified as potentially avoidable through the provision of good quality health care. They are also more likely to have problems in having their needs identified and appropriate care provided. Their families or carers also reported having problems getting their views heard.

9. Why we need a palliative care pathway for learning disability
Increasing population and people with a learning disability are living longer
High incidence of premature deaths in LD population
Health Inequalities and Discrimination
Different disease profiles
Diagnostic overshadowing
Profound and Multiple Learning Disability
09/05/2019

10. Hopes for the Future
Key Practitioners to be identified; recognized learning disability champion nurses and palliative care nurses selected from their respective teams and hospices.
The hope is for the team to meet regularly to develop, skills, knowledge and confidence within a framework of partnership and collaborative working and for practitioners to come to realize that they have a shared philosophy of holistic and person centered care .
This concept will ensure that PWLD who have palliative care needs are recognized and better placed to receive more equitable and robust care.
09/05/2019