This December EBN has been sharing inspiring blogs from across all the fields of nursing and midwifery practice.  This week we are delighted to bring you three contributions from Learning Disability Nursing.  Today’s blog comes from Professor Ruth Northway on the topic of meeting the needs of older people with learning disabilities.  Remember to check out our forthcoming blogs from Learning Disability Nurse Jonathan Beebee & Learning Disability Student Nurse Amy Wixey on Wednesday and Friday of this week!

Meeting the health needs of older people with learning disabilities: the challenge for nurses

The Confidential Inquiry into Premature Deaths of People with Learning Disabilities (CIPOLD) (Heslop et al, 2013) found that the median age of death for men with learning disabilities was 13 years less than that of their non-disabled peers, whilst for women with learning disabilities there was a 20 year gap when compared with women without learning disabilities. Premature and avoidable deaths therefore remain an issue for people with learning disabilities (Heslop et al, 2013) and there is much that needs to be done to improve both access to, and quality of, health services for this group of people. However, despite such disparities we also know that overall life expectancy of people with learning disabilities is increasing and that this means that we have a growing population of older people with learning disabilities (Havemann et al, 2011).

Ageing is often accompanied by an increase in chronic, and often multiple, health problems and this also applies to older people with learning disabilities. However, they may face additional challenges due to the combined effects of living with a life-long disability and the more general effects of ageing. For example they may have a long history of poor access to healthcare provision and we know that they often experience less healthy lifestyles (for example higher rates of obesity and lower levels of exercise) that can negatively impact on health and the ageing process. As a consequence not only is multi-morbidity very prevalent amongst older people with learning disabilities but also the ageing process can also start earlier with there being some consensus that some people may be considered to be ‘old’ from the age of 50 onwards (Hermans and Evenhuis, 2014).

So what does this evidence mean for nurses and other health care providers? How best to support older people with learning disabilities is a topic of much debate within the literature. Whilst some may live independently and some with their families, others will be living in various small group settings where they may be supported by staff who do not have specific training in relation to health issues. Research that I have recently been involved in looking at the needs of this staff group has shown how important it is for them to be able to call upon primary and secondary health care professionals to assist them in meeting the sometimes complex needs of those they are supporting. In some instances (such as when someone develops late stage dementia or requires end of life care for another reason) it is no longer possible to support them within the group home and so difficult decisions have to be made as to what is the most suitable setting for an individual: in some instances this may be a nursing home or a hospice. What is evident, therefore, is that all nurses regardless of area of specialism, and whether they work in primary or secondary care, have a role both in trying to promote healthy ageing for people with learning disabilities and in ensuring that they receive timely and effective healthcare when it is required. We need to be aware of, and use, the evidence relating to the health needs of older people with learning disabilities to ensure that we are up to meeting this challenge.

Ruth Northway

References:

Haveman, M., Perry, J., Salvador-Canula, L., Noonan-Walsh, P., Kerr, M., van Schrojenstein Lantan-de-Walk, H., van Hove, G., Berger, D.M., Azema, B., Buono, S., Cara, C.C., Germanavicus, A., Linehan, C., Maata, T., Tossebro, J., Weber, G. (2011) Ageing and health status in adults with intellectual disabilities: results of the European POMONA II study, Journal of Intellectual Disability Research, 36 (1) 49 – 60

Hermans, H., Evenhuis, H.M. (2014) Multimorbidity in older adults with intellectual disabilities, Research in Developmental Disabilities, 35, 776 – 783

Heslop, P. Blair, P. Fleming, P., Hoghton, M., Marriott, A., Russ, L. (2013) Confidential Inquiry into Premature Deaths of People with Learning Disabilities, Bristol: Norah Fry Research Centre, University of Bristol

Check out EBN’s own top 5 recommended resources on Learning Disability below:

1. Chue, P. (2014) ‘In adults with intellectual disability, discontinuation of antipsychotics is associated with reduction in weight, BMI, waist circumference and blood pressure’, Evidence-Based Nursing, 17, (3), pp. 89
2. Bressington, D. and Tong-Chien, W. (2015) ‘Case study: Guidelines improve nurses’ knowledge and confidence in diagnosis of anxiety and challenging behaviours in people with intellectual disabilities’, Evidence-Based Nursing, Published Ahead of Print doi:10.1136/eb-2015-102168
3. EBN Podcast with Professor Chue on intellectual disability and antipsychotic medication.
4. Balandin, S. (2008) ‘Inpatients with cerebral palsy and complex communication needs identified barriers to communicating with nurses’, Evidence-Based Nursing, 11, (1), pp. 30.
5. EBN Guest Blog by Carole Beighton on Parenting Children with Intellectual Disabilities