what is a learning disability
- significantky reduced ability to undertsand new or complex info or learn new skills
with
-reduced ability to cope independantly (social function)
-started before adulthood - with lasting effects on development
NICE criteria for a learning disability
- low intellect (IQ <70)
2.significant impairment of social or adaptive functioning
3.onset in childhood
Mild LD
85% have Mild LD where they can generally read and write and be independant
moderate LD
10% of Px most can read and write but require some supervision/oversight
severe LD
3% of Px not able to read or write may be able to learn routines require supervision
profound LD
1-2% of Px require intensive support
how many people have LD in UK
1.1 million almost 1in 218 have a LD
risk factors of LD
-childhood brain injury
-childhood illness
-prenatal exposrures (eg alcholol, sodium valporate)
-chromosonal/genetic anomolies
-non genetic congenital malformations
-birth complications
-extreme prematurity (<33 weeks gestation)
approx 50% of Px suffer from co-morbidities because they find it difficult to assess health needs and/or communicate - what are some comorbidities
-obesity or underweight
-20x increase in risk of epilepsy
-increased rate of constipation/ dyspepsia/thyroid/ eczema/parkinsons /dysphagia
-visual/hearing impairments
chances of mental health co-morbidities
Adults 40%
children 36%
22% cvhnace of dementia over 6% in general population
Social inequlaities
-live in rented/overcrowded accom
-be exposed to tobbaco smoke
-be bullied and/or physically, sexually, emotionally abused
-have less social support
60% of LD children live in poverty
why are Px with learning disabilities more likely to die 13-20yrs earlier than general population?
- due to co-morbidities
-higher risk of inadequate/ innapropriate treatment
challenging behaviour is seen in 5-15% of Px in eductaional health settings and 30-40% in hospital settings - What is it?
-aggression
-self-injury
-sterotypical behaviour
-withdrawal
-destructive/disruptive behaviour
risk factors of challenging behaviour
- severe LD
-autism
-dementia
-communication difficulties
-visual impairment
-age
-living in innapropriate environment
management of challenging behaviour
1st line treatment psychiatric intervention
1. assessment of Px - environmental/biologic triggers
2. prevention and overcoming triggers (eg reducing loud noise)
3.improve QoL
4. second line treatment combination therapy with medication
conditions of using medication for challenging behaviours
- psychyatric intervation alone was innafective
- treatment of co-existing mental health issues has not reduced behaviour
3.severe risk of harm to self and others
What should be included in LD annual health check
- physical health review
-medication review
-agreed shared care plan for management of physical health
note - checks are not usually carried out properly and uptake rate is only around 50%
STOMP
- stopping overmedicating of people with LD and/or autism
-encourage Px to have regular checkups about psychotropic meds
-make sure Px and fam are involved in decisions - implement non medication therapies
Role of a pharmacist in STOMP
-Active role/lead in STOMP
-review medications
-deprescribe medications not indicated or causing problems
-ensure appropriate monitoring
