Week 9: Physical Health And Id.

Front 1

Prevalence of health problems.

Back 1

- Kerr, people with ID suffer an increase in common morbidity and a higher prevalence of serious conditions associated with aetiology of illness.
- welsh health survey, higher rates of psychiatric illness (32.2%) more suffer epilepsy (22%).
- Lennox & Kerr, arguably a higher prevalence of both mental and physical illness, greater health needs.
- Morgan et al, higher mortality rates BUT there are predictors of mortality.
- Webb & Rogers, ID have a larger number of untreated common conditions compared to TD.

Front 2

Common Health Problems.

Back 2

SENSORY DEFICITS:
McCulloch, visual deficits 12% mild 40% severe 100% profound. / hearing loss prevalent in all ID.
EPILEPSY:
16% in ID whilst <1% in TD/ linked to severity/ >institu
OBESITY:
More common in ID/ Rimmer, 29-50% ID/ Bell & Bhate, certain conditions more e.g turners/ linked diseases.
OTHER DISORDERS:
- dental, 86% dental problems ID
- mortality, feeding difficulties and sudden death synd
- gastro reflux, hard to diagnose.

Front 3

Common health problems

Back 3

Beange et al, Australia, significantly increased level of obesity, vision and hearing deficits, skin disease and mental illness in ID population.

Front 4

Risk factors for ill health.

Back 4

Nutrition: dysphasia and pica.
Inactivity: immobility common in ID, not enough staff to monitor exercise, uneducated on the benefits.
Smoking: 10-36% ID, 26% TD, group homes more.
Medication: poly pharmacy common in most, increased risk of side effects.

(Genetic make up and life style factors are the major determents of health)

Front 5

Barriers to health care

Back 5

1. Mobility/Access: many ID have immobility, caught early can prevent other illnesses associated/ 12% North USA were inaccessible.
2. Sensory Impairment: due to lack of language and comprehension, can't attend appointments alone.
3. CB: 20% of ID only examined after pre measures/ 1 in 5 doctors said they could not cope with CB.
4. Communication: reliance on carer/ 50% missed sensory impairments of ID.
5. Knowledge and Attitudes: doctors lack of knowledge/ lack of knowledge in top 5 struggles.

Front 6

Primary Health Care for ID

Back 6

Three areas consistently found;
1) untreated, yet treatable condition.
2) untreated specific health issues to ID
3) a lack of uptake of health promotion
Whitfield, random sample ID and TD, ID on more medication however TD more Bp checks.

Front 7

Addressing disparity - (policy)

Back 7

- value people
- everyone should have the right to mainstream care.
- most important function of the dr is to act as a catalyst and driver of general health improvement by facilitating pathway to care.

Front 8

Addressing disparity - (primary care)

Back 8

Central to improving ID health.
Current assessment;
1) assessment of initial complaint
2) recognition and assessment of comorbity
3) recognition of health promotion status
Jones and Kerr, this criteria has not been met in UK.

Front 9

Addressing disparity - (primary care)

Back 9

Ways to change/improve:
1) practice organisation: we need to value people/ services should be regularly updated and maintained.
2) practice registers: all ID should be identifiable on register and updates recorded.
3) recall and audit: check effectiveness of treatments/ ensure appropriate referrals are made.
4) contact with other services: contact other services and see what care is being given there.
5) clinical competencies: provide care that is specific to ID

Front 10

Addressing disparity - (specialist psychiatric care)

Back 10

- equally as important for ID.
- especially good when mental and physical is combined.
- staff training, competence need to be taught to deal with ID, need to establish an effective partnership.

Front 11

Hunt, Wakefield & Hunt - nurse screening.

Back 11

1) 35 adults ID, screening, help get treatment and break down barriers.
2) nurse drop in sessions (known setting), have a ok health check (question careers too).
3) a gateway to primary health care.
4) nurse goes to doctor appointments and provide info on other ID friendly services.
5) ways to prepare ID, especially anxious.
6) provide users with further info and education.
Results: 91% referred to gp and detected problems and treated.
Limitations: thought would further the gap and how could doctors improve if another service.