This week’s EBN Twitter Chat, on Wednesday 16th March 2016 between 20:00 – 21:00 hrs (GMT), will focus on the role of nurses and midwives in meeting the health needs of people with learning (intellectual) disabilities. The Twitter Chat (#ebnjc) will be hosted by Ruth Northway (@NorthwayRuth) who is a Professor of Learning Disability Nursing.
There is growing international evidence that people with learning (intellectual) disabilities experience inequalities in relation to their health (for example Anderson et al, 2013; Emerson et al, 2011; Krahn and Fox, 2014). Whilst, overall, their life expectancy has increased over the past century (Coppus, 2013) they still, on average, have a reduced life expectancy compared with the general population (Coppus, 2013; Heslop et al, 2013).
Emerson et al (2011) present evidence suggesting that there are a number of factors that contribute to such inequalities namely:
· People with learning (intellectual) disabilities may be at increased risk of exposure to established determinants of poorer health such as poverty. They may also experience increased vulnerability when exposed.
· Some genetic and biological causes of learning (intellectual) disabilities may lead to increased risks of certain health problems.
· They may experience communication difficulties and have reduced health literacy.
· They may engage in behaviours that lead to increased personal health risks.
· They may experience poor access to healthcare and other support services. When such services are received they may not be of an acceptable quality.
It can be seen from this list that many of these factors are amenable to change and hence many of the health inequalities experienced are not an inevitable consequence of having a learning (intellectual) disability. However, being aware of this is not sufficient: action is needed to change systems, services and supports.
Nurses have the potential to make a significant impact in bringing about such changes both at the level of individual practice and at a strategic level in terms of policy and service development. However, to realise this potential nurses need to be aware of the health needs of people with learning (intellectual) disabilities and feel confident and competent to identify and meet such needs. Furthermore all nurses (not just those specialising in working with this client group) need to possess such knowledge and skills since people with learning (intellectual) disabilities require access to mainstream primary, secondary, and tertiary health services across their lifespan: all nurses wherever they work should be supporting such access. However, research has shown that healthcare staff (including nurses) feel that they need further training regarding the health needs of people with learning (intellectual) disabilities and, in particular, in relation to communication issues (Hemm et al, 2015). Two key questions for discussion therefore emerge:
1. How can all nurses contribute to reducing the health inequalities experienced by people with learning (intellectual) disabilities?
2. What education and support do they need in order to make such contributions?
Anderson, L.L., Humphries, K., McDermott, S., Marks, B., Sisirak, J., Larson, S. (2013) The state of science of health and wellness for adults with intellectual and developmental disabilities, Intellectual and Developmental Disabilities, 51 (5) 385 – 398
Coppus, A.M.W. (2013) People with intellectual disability: what do we know about adulthood and life expectancy? Developmental Disabilities Reviews, 18, 6 – 16
Emerson, E., Baines, S., Allerton, L., Welch, V. (2011) Health Inequalities and People with Learning Disabilities in the UK 2011, https://www.improvinghealthandlives.org.uk/securefiles/160302_1539//IHaL%202011-09%20HealthInequality2011.pdf
Hemm, C., Dagnan, D., Meyer, T.D., (2015) Identifying training needs for mainstream healthcare professionals to prepare them for working with individuals with intellectual disabilities: a systematic review, Journal of Applied Research in Intellectual Disabilities, 28, 98 – 110
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
Krahn, . Fox, M.H. (2014) Health disparities of adults with intellectual disabilities: what do we know? What do we do? Journal of Applied Research in Intellectual Disabilities, 27, 431 – 446
Buszewicz, M., Welch, C., Horsfall, L., Nazareth, I., Osborn, D., Hassiotis, A., Glover, G., Chauhan, U., Hoghton, M., Cooper, S.A., Moulster, G., Hithersay, R., Hunter, R., Heslop, P., Courtenay, K., Strydrom, A. (2014) Assessment of an incentivised scheme to provide annual health checks in primary care for adults with intellectual disability: a longitudinal cohort study, Lancet Psychiatry, 1, 522-30
Emerson, E. (2015) The determinants of health inequities experienced by children with learning disabilities, London: Public Health. Accessible via http://www.improvinghealthandlives.org.uk/securefiles/160310_1944//Determinants%20of%20Child%20Health%20Inequalities.pdf
Haveman, M., Heller, T., Lee, L., Maaskant, M., Shoostari, S., Stydrom, A. (2010) Major health risks in ageing persons with intellectual disabilities: an overview of research studies, Journal of Policy and Practice in Intellectual Disabilities, 7 (1) 59 – 69
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
Mencap (2007) Death by Indifference, London: Mencap. Accessible from https://www.mencap.org.uk/death-by-indifference
https://www.improvinghealthandlives.org.uk/ The website of Improving Health and Lives – a public health observatory focused on the needs of people with learning (intellectual disabilities). A range of reports can be accessed and downloaded from this site.
http://www.intellectualdisability.info/ A website hosted by St George’s Medical School which includes a range of information regarding the physical and mental health needs of people with learning (intellectual) disabilities