People with Learning Disability

People with a learning disability have a significantly reduced ability to understand new or complex information, to learn new skills and to cope independently²⁰. Unfortunately, this vulnerable group experiences a higher incidence of health problems^{1 20 21} and is at increased risk of premature death^{22 23} compared with the general population.

In the UK, 1.2 million adults are thought to have mild or moderate learning disabilities, with 210,000 people believed to have more severe or profound learning disabilities^{20 21}. Whilst the prevalence of dysphagia among adults with learning disabilities is difficult to estimate – figures range from 36% based on general speech and language therapy caseloads, to 73% based on inpatient populations²⁴ – it has been identified as a particular problem for patients and carers²⁵ and a significant area of health risk^{26 27 28}.

The incidence of dysphagia among people with learning disabilities is often due to the effects of hypotonia (decreased muscle tone), hypertonia (excessive muscle tone) and poor co-ordination. Also, having a reduced IQ means that some people with learning disabilities may be unaware that certain foods, such as tough meat that must be chewed, require specific masticatory preparation before it is swallowed.

Diagnosis and management can often be complicated by cognition and communication difficulties: 50% of people with learning disability have significant communication problems and up to 80% have some communication problems²⁹. This makes both the observation of patients during a meal and the involvement of carers in diagnosis, care planning and management, particularly important. Despite these challenges, there has been limited support for healthcare professionals in the identification and management of dysphagia in people with learning disabilities. Whilst the NPSA has provided resource materials³² it wasn’t until 2013 that practical guidance became available when a multidisciplinary group of UK clinicians developed the Guidelines for the Identification and Management of Swallowing Difficulties in Adults with Learning Disability³⁰. The guideline provides information for professionals on the recognition, diagnosis and management of dysphagia and referral pathways. It also highlights the various legal and professional considerations applicable to this particular patient population, including those pertaining to prescribing and medicines administration. The guideline also emphasises the importance of medication review in patients with learning disabilities citing the ‘NO TEARS’ tool³¹ as a useful and simple aid.