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Learning Disability

Learning Disabilities – valuing the expertise of Dietitians

Dietitians are the only nutrition professionals to be statutorily regulated, and have an ethical code that ensures the highest work standards. Dietitians are up to date with current research, public health and translate the science behind research and guidance into manageable, practical information to enable people to make appropriate lifestyle and food choices.

The Department of Health in England (DH 2001) defined learning disability as: a significantly reduced ability to understand new or complex information, to learn new skills (impaired intelligence) along with a reduced ability to cope independently (impaired social functioning). The onset of disability is considered to have started before adulthood, with a lasting effect on development. This definition includes IQ and functional aspects that make it distinct from the use of the term “learning difficulties” which has a far wider application in education (DH 2001).

The terms “mild”, “moderate” and “severe or profound” learning disabilities appear to suggest distinct categories for learning disability but in reality these do not adequately describe the range of impairments or disabilities this group may have. Someone with autism, for example, who has learning disabilities may have significant social difficulties and appear to have moderate learning difficulties, yet may be able to look after their own personal care and everyday needs quite independently (RCN 2010).

Learning disability is one of the most common forms of disability and affects up to 1.5 million people in England alone (Emerson and Hatton 2008). Over 200,000 children in England (2.6 per cent) have a primary special educational need associated with learning disabilities. This is likely to be a significant underestimate (Emerson and Hatton 2008).

People with learning disabilities are living longer. In the 1930s average life expectancy was estimated to be less than 20 years of age (Holland 2008). Mean life expectancy is now estimated to be 74, 67 and 58 for those with mild, moderate and severe learning disabilities respectively (Bittles et al 2002). The number of adults with learning disabilities is predicted to increase by 14 per cent between 2001 and 2021, resulting in more than a million people with learning disabilities by 2021 (Emerson and Hatton 2008).

 

Many individuals with LD or their carers seek support from Dietitians:

People with LD are at greater risk of developing nutritionally related health problems. Issues around body weight, swallowing difficulties, bowel disorders, reflux, diabetes and oral health are all commonly seen(1, 2).

People with a LD living independently are more likely than the general population to live in a low income group, to be unemployed and socially isolated within a challenging environment.  These factors are known to promote poor eating habits (3).

People with LD have a 58% increased risk of dying before 50 when compared to general population (4). Respiratory diseases such as pneumonia are the is a more common cause of death in LD, 19.8% compared to 15% in the general population(5). British studies have shown that death due to respiratory conditions in those with LD was between 26% and 40% of total LD deaths (4, 6).  Risk of developing pneumonia is closely linked to swallowing problems resulting in aspiration of food and fluids into the lungs.  You are more at risk of swallowing problems if you have poor or weak muscle control/coordination, poor posture, feeding difficulties and reflux disease.  All of these risk factors are more likely in the LD population as they form part of many conditions which cause LD(1, 4, 7).

 

A Dietitian’s role:

Dietitians are a diverse, skilled profession, and are key members of teams helping individuals with LD, often holding multi-facetted roles:

a)    Clinicians – Dietitians give individualised, holistic advice – taking into account the wider medical, social and cultural situation.  Their advice is always non-biased, based on best practice and practical. Dietitians provide support and advice, with the emphasis on minimising the risk of nutritional inadequacy.  Dietitians often lead or contribute to specialist feeding teams tackling rigid feeding choices, food phobias, dysphagia, long term enteral feeding and sensory feeding issues(1, 8).

b)    Behavioural change experts – Dietitians are skilled in using approaches to helping individuals change their diet and related lifestyle(9).

c)    Trainers and educators –    Training is targeted and specific taking account of nutritional challenges faced with LD.  Information provided for individuals will take into account inclusive communication and will be appropriate to level of understanding(7). Information and on-going structured education for chronic conditions such as diabetes, should be developed appropriate to the learning needs of this client group, NICE CG 66.  Dietitians are central to development, implementation of this.

d)    Advocates and champions – our priority is to ensure good food provision and appropriate management of nutrition related problems. Dietitians also contribute to national guidelines via SIGN and NICE(10).

e)    Researchers – Dietitians undertake research and audit to evaluate their services to improve the life of people with LD(8).

 

Dietitians are cost-effective

As well as being a great source of expertise and support to carers and individuals with a learning disability and their teams, there are a number of key ways in which an effective dietetic service can reduce other public spending:

  • By reducing or eliminating the need for medications in the management of constipation and other gut problems.
  • Making improvements in nutrition that can promote an individual’s learning and development and so reduce their need for support in the future
  • Minimising medical problems that can result in increased need for medical care for example in weight management, malnutrition, swallowing problems, tube feeds and diabetes(1).

 

References

  1. H. Crawley, Caroline Walker Trust., Eating well : children and adults with learning disabilities ; nutritional and practical guidelines.  (The Caroline Walker Trust, Abbots Langley, Herts., 2007), pp. 159.
  2. B. M. Appelhans et al., Socioeconomic status, energy cost, and nutrient content of supermarket food purchases. Am J Prev Med 42, 398 (Apr, 2012).
  3. M. C. Conry et al., The clustering of health behaviours in Ireland and their relationship with mental health, self-rated health and quality of life. BMC Public Health 11, 692 (2011).
  4. S. Hollins, M. T. Attard, N. von Fraunhofer, S. McGuigan, P. Sedgwick, Mortality in people with learning disability: risks, causes, and death certification findings in London. Dev Med Child Neurol 40, 50 (Jan, 1998).
  5. Disability Rights Comission, Equal Treatment: Closing the gap. A formal investigation into physical health inequalities experienced by people with learning disabilities and/or mental health problems. DRC, London,  (2006).
  6. G. Glover, M. Ayub, How people with learning disabilities die. IHAL: Learning Disabilities Observatory,  (2010).
  7. M. Kerr, Improving the general health of people with learning disabilities. Advances in Psychiatric Treatment 10, 200 (2004).
  8. N. Qureshi, Trust a Dietitian to know about Nutrition (British Dietetic Association, Birmingham, UK, 2007).
  9. J. Gable, Counselling Skills for Dietitians.(John Wiley & Sons, Ltd., Chichester, 2008),  pp. 272.
  10. The British Dietetic Association, Code of Professional Conduct (BDA, Birmingham, UK, 2008).

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