The health problems of people with intellectual disabilities are sometimes challenging for health professionals but often remain unrecognised and unmet, according to a review.
The prevalence of significant intellectual disability in the community had been estimated at about 0.7%. While the term was used as a convenient summary of disability, it failed to capture the complex and multifaceted problems that could occur in intellectual function and adaptive behaviour.
The most common primary health problems accompanying intellectual disability were epilepsy, mobility difficulties and sensory deficits. Mental health difficulties were also common, the most prevalent being problem behaviour.
A number of secondary health problems could occur. They included obesity, poor oral health, and gastro-oesophageal reflux disease. Sometimes the simplest issues were neglected: for example, oral health was often poor and toothache could manifest as challenging behaviour. Constipation could result from many factors including lack of mobility, cerebral palsy, medications, and refusal to eat.
The review cited “excellent” Australian guidelines, released in 2005, on consulting with people who had intellectual disabilities. They stressed that it was important to focus on abilities, not disabilities, to talk respectfully (without shouting), and take time to explain what was happening. Other points in the guidelines included:
· Greet the patient first, before addressing the accompanying relative or support person.
· Invite new patients to bring any existing health records with them, as paid support staff might be unaware of vital aspects of their medical history.
· Check the patient’s verbal capacities, as there may be an imbalance between receptive and expressive language skills.
· Obtain the history from the patient as far as possible, but otherwise accept the assistance of the accompanying person.
· Make it clear that if the patient wants the accompanying person to leave at any time during the consultation, they should indicate their wish.
· Use the wealth of communication aids now available to compensate for limited verbal skills, ranging from gestures, facial expressions and sign language to pictorial and electronic devices.
Reference
van Schrojenstein Lantman-de Walk, H. Noonan Walsh, P. 2008, ‘Managing health problems in people with intellectual disabilities.’ BMJ Online First published online.
Abstract