How will you as the community nurse adapt and implement this strategy/intervention to ensure optimal health and wellbeing across the woman?s lifespan
?School of Nursing and Midwifery Page 1 of 5 University of Western Sydney
Reassessment Essay: Case history review Weighting: 50% Word count: 1500 words (+/- 10%) Due Date: 28th October, 2016 Submission details: Refer to Submission Requirements in your Learning Guide for HV2 Marking Criteria and Standards: See pages 3-11 Aim of assessment
The aim of this assessment is to enable students to identify, critically examine and report on the effective nursing management of chronic illness in people with a functional disability across the lifespan. This will assist in better preparing the student for professional practice when working with people with a disability and chronic illness. Details:
CASE HISTORY: Students are to focus on the following case history: an adult woman of 45 years with a moderate intellectual disability. This woman also has a chronic illness which is epilepsy. This woman lives in a community group home that is staffed by support workers and she attends a disability-specific day program Monday to Friday. You are the community nurse managing the holistic care needs of this woman. QUESTION: Review the literature and write a 1500 word essay based on the case history listed above that answers the following statement: ?Critically analyse the health effects on a person of having intellectual disability and a chronic illness and the impact of the nurses? ability to promote the health and wellbeing of the person?.
401014 ? Health Variations 2 Reassessment Task ? Spring 2016
?School of Nursing and Midwifery Page 2 of 5 University of Western Sydney
The assessment criterion consists of the following guided statements: 1. Critically analyse the health challenges that may arise across this woman?s lifespan as a result of her moderate intellectual disability and epilepsy. Interpret how these health challenges may impact on her health and wellbeing. (10 marks: approximately 300-350 words) 2. Using the ICF Model, discuss how the woman?s activity and participation are potentially affected across her lifespan. (10 marks: approximately 300-350 words)
3. Identify x1 nursing intervention/strategy for managing epilepsy from the peer reviewed literature (journals only). How will you as the community nurse adapt and implement this strategy/intervention to ensure optimal health and wellbeing across the woman?s lifespan? That is, what will YOU DO as the nurse for this woman and the staff who support her and HOW will you do it in order to better manage her epilepsy and to make sure that the woman is included as much as possible? Examples of interventions/strategies include, but are not limited to: self-management of medication, dietary modifications, managing day-to-day risk, relaxation therapy, counselling, seizure first aid education, and epilepsy education. Students need to first name and describe the intervention/strategy and then discuss in detail how, as the nurse, they will adapt and then implement this intervention/strategy (20 marks: approximately 700-750 words).
4. Academic writing style. (5 marks)
5. Referencing. (5 marks)
NOTE: 1. Students must write an essay that consists of an introduction, a body and a conclusion plus a reference list in APA 6th Edition style with a minimum of 6 peer reviewed academic references. Reference list and in-text citations are NOT included in the word count. The introduction and conclusion will be approximately 100 words each. It is appropriate to cite the literature in your introduction and conclusion. 2. There is a word limit of 1500 words. Use your computer to total the number of words used in your assignment. However, do not include the reference list at the end of your assignment in the word count. In-text citations will be included in the additional 10% word count. If you exceed the word limit by more than 10% the marker will stop marking at 1650 words plus 10%.
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Marking criteria and standards: Assessment 1 ? Essay: Case history review with guided questions Criteria Mark High Distinction Distinction Credit Pass Fail Critically analyses the health challenges and potential impact of these across lifespan.
/10
An outstanding attempt at analysing the health challenges and potential impact of these for the person across their lifespan. Makes an outstanding attempt at moving narrative toward a sophisticated interpretation of the key issues.
An excellent attempt at analysing the health challenges and potential impact of these for the person across their lifespan. Makes an excellent attempt at moving narrative toward an advanced interpretation of the key issues.
A good attempt at analysing the health challenges and potential impact of these for the person across their lifespan. Makes a good attempt at moving narrative toward a compelling and logical argument.
Partially analysing the health challenges and potential impact of these for the person across their lifespan. Some logical argument, but limited.
Poorly analysing the health challenges and potential impact of these for the person across their lifespan.
8.5 – 10 7.5 ? 8.0 6.5 ? 7.0 5 – 6 =4.5
Using ICF Model, discuss how the person?s activity and participation are affected by having a disability and chronic illness.
/10
Using the ICF model provides an outstanding attempt at discussing how the person?s activity and participation are potentially affected. Makes an outstanding attempt at moving narrative toward a sophisticated interpretation of the key issues.
Using the ICF model provides an excellent attempt at discussing how the person?s activity and participation are potentially affected. Makes an excellent attempt at moving narrative toward an advanced interpretation of the key issues.
Using the ICF model provides a good attempt at discussing how the person?s activity and participation are potentially affected. Makes a good attempt at moving narrative toward a compelling and logical argument.
Using the ICF model provides a partial attempt at discussing how the person?s activity and participation are potentially affected. Some logical argument, but limited.
Poorly describes the ICF with unclear discussion about how the person?s activity and participation are potentially affected.
8.5 – 10 7.5 ? 8.0 6.5 ? 7.0 5 ? 6 =4.5
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Criteria Mark High Distinction Distinction Credit Pass Fail Interventions and strategies for managing the chronic illness. Discussion about how these can be adapted to enhance the health of the person.
/20
Clear and coherent description of intervention/ strategy and outstanding discussion about the nurses? role in adapting these for the person with a disability and chronic illness. Makes an outstanding attempt at moving narrative toward a sophisticated interpretation of the key issues.
Clear and coherent description of intervention/ strategy and excellent discussion about the nurses? role in adapting these for the person with a disability and chronic illness. Makes an excellent attempt at moving narrative toward an advanced interpretation of the key issues.
Sound description of intervention/ strategy and good discussion about the nurses? role in adapting these for the person with a disability and chronic illness. Makes a good attempt at moving narrative toward a compelling and logical argument.
Satisfactory description of intervention/ strategy and partial discussion about the nurses? role in adapting these for the person with a disability and chronic illness. Some logical argument, but limited.
Poorly describes intervention/ strategy and limited discussion about the nurses? role in adapting these for the person with a disability and chronic illness.
17-20 15-16.5 13.5 – 14.5 10 ? 13 =9.5
Academic Writing Style
/5
Excellent use of academic English. No spelling or grammatical errors.
Unambiguous language where meaning is always clear. No spelling or grammatical errors.
Ideas are well expressed with clear language and few spelling or grammatical errors.
Language is acceptable with some spelling and grammatical errors. Meaning is mostly clear.
Reads like a first draft. Sentences and/or paragraphs are unclear, confused or disorganised. Contains multiple spelling and grammatical errors. 5 4-4.5 3-3.5 2.5 =2
Referencing
/5
Referencing (in text and reference list) is complete and accurate with flawless application of APA style
Referencing (in text and reference list) is complete and accurate with only 1-3 minor deviations from APA style.
References complete with a few (< 5) lapses in APA style.
References largely complete (only 1-2 missing references) but with multiple lapses (5+) in correct APA style.
References seriously incomplete or non- existent with multiple lapses in correct APA style.
5 4-4.5 3-3.5 2.5 =2
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Introduction
Health issues for people with intellectual disabilities: the evidence base
Robert Davis, Renee Proulx, and Henny van Schrojenstein Lantman-de Valk
People with intellectual disability experience significantly more health problems than the general population. Furthermore, there is considerable evidence that people with intellectual disability do not receive the same level of health care as other members of society. For exam- ple, health screening medical checks are given less often to people with intellectual disability than to the non-disabled population (Evenhuis et al. 2001), yet it has been shown consistently that health checks lead to detection of unmet health needs and lead to targeted actions to address health needs (Lennox et al. 2006; Robertson et al. 2007) (see Chapter 18). Jurisdic- tions across the world are signatories to the UN Convention on the Rights of Persons with Disabilities (2006), which states: ‘parties recognize that persons with disabilities have the right to the enjoyment of the highest attainable standard of health without discrimination on the basis o.f disability’. The UN Convention (2006) further states that parties shall ‘provide persons with disabilities with the same range, quality and standard of free or affordable health care and programmes as provided to other persons, including … population-based public health programmes’. Another core point the UN made was that service providers should offer ‘health services needed by persons With disabilities specifically because of their disabilities, including early identification and intervention as appropriate, and services designed to minimize and prevent further disabilities, including among children and older persons’. Access to health promotion and illness preven- tion services would be included within this remit. While the gap is narrowing in some countries, on average people with intellectual disabil- ity have more significant health problems and die younger than their non-disabled peers, par- ticularly those in the severe to profound range (Ouellette-Kuntz et al. 2005; Krahn et al. 2006). People with moderate to severe intellectual disabilities are three times as likely to die early than the non-disabled population (Turner 2011). This is due in part to the underlying cause of their disability and in part to predisposing and interrelated factors such as poverty, illiteracy and other social determinants. Improved health is likely to lead to improved quality of life for both the individuals with intellectual disability and their families. In this chapter, we review the evidence base for the major health problems of this population and provide readers with a synopsis of the up-to-date evidence of the health status of people with intellectual disability. We identify indi- vidual health targets and implications for health promotion, and examine the importance of the role of empirical evidence and how this needs to be clearly translated into practice.
8 The health promotion needs of people with intellectual disabilities
Definitions
Intellectual disability
Intellectual disability is ‘a disability characterised by significant limitations in intellectual func- tioning and in adaptive behaviour, which covers many everyday social and practical skills. This disability originates before the age of 18 years’ (AAIDD 2012). One criterion for determining the presence of intellectual disability is a standardized measure of intellectual functioning or IQ test. Significant impairment measured through this rating is said to be two standard deviations below average, which translates to an IQ that is below 70. There are also standardized measures for adaptive behaviour that include conceptual, social and practical skills. The term intellectual disability is synonymous with previous terms such as mental retarda- tion and mental handicap, and with terms used in other jurisdictions such as learning disability. People with intellectual disability have a broad range of abilities and these abilities will signifi- cantly influence the way they interact with the community, the types of choices they have in their lives, and the degree to which others support them. According to the World Health Organization intellectual disability can be categorized as follows:
? Mild (IQ of 50-70)- the ability to communicate effectively and live relatively independently with minimal support within the community. ? Moderate (IQ of 35-49) – individuals who, with lifelong support, will have significant rela- tionships, can communicate, handle money, travel on public transport, make choices for themselves, and understand daily schedules. ? Severe or Profound (IQ <34)- individuals who are almost totally dependent on those around them and will require lifelong help with personal care tasks, communication, and accessing and participating in community facilities, services and activities.
There is a wide range of aetiologies for intellectual disability, including chromosomal, single gene deficits, a range of environmental factors that include intra-uterine infections (for example, maternal rubella), peri-natal trauma, nutritional deficits (for example, iodine deficiency), mater- nal alcohol abuse, and childhood neglect and deprivation. In approximately half of cases no cause has yet been identified. The variation in social, political, economic and environmental factors influence the prevalence of particular causes of intellectual disability in each country, as they do the health and nutritional status of the non-disabled population.
Developmental disability
Developmental disabilities are those that relate to ‘differences in neurologically based func- tions that have their onset before birth or during childhood, and are associated with significant long-term difficulties’ (Graves 2003). As such, developmental disability is an umbrella term that includes intellectual disability but also includes other disabilities that are acknowledged during early childhood. Some developmental disabilities are derived largely from physical impairments, such as cerebral palsy and epilepsy. Some individuals may have a condition that includes a physi- cal and intellectual disability, such as Down syndrome or foetal alcohol syndrome. Other devel- opmental disabilities, such as cerebral palsy or autism spectrum disorders (autism or pervasive developmental disorder [PDD]) are often associated with intellectual disability, further adding to the complexity of their physical and mental health needs.
Health problems of people with intellectual disability
People with intellectual disability have a range of health vulnerabilities when considered as a population; however, specific aetiologies of intellectual disability carry with them more defined
Health issues for people with intellectual disabilities 9
risk profiles. Most of the large prevalence studies of health problems in this population are based on indirect assessments of the knowledge of staff of their clients’ health status. The real preva- lence tends to be underestimated because of the reduced ability of the individual with intel- lectual disability to present with symptoms, the difficulty for staff to recognize symptoms and signs, and limitations in the skills and available time of physicians to make their assessments (Haveman 2004). The prevalence of these problems has been found to be much higher in studies where direct assessment measures were undertaken by skilled clinicians. People with intellectual disability are one of the most marginalized groups in our society, as they have extremely limited access to education, employment, and financial resources. They are subject to the very powerful social determinants of health, poverty, and social class. Epidemio- logical studies of the health of people with intellectual disability have looked at both their health in general as well as specific health problems (Van Schrojenstein Lantman-de Valk and Walsh 2008). These have shown that this group is particularly vulnerable to a range of chronic health problems that include:
? sensory problems (including vision, hearing and dental) ? poor nutrition ? constipation ? thyroid problems ? gastro-oesophageal reflux disease (GERD) and Helicobacter pylori ? obesity ? osteoporosis ? epilepsy ? cardiovascular disease ? Type 1 and Type 2 diabetes ? some types of cancers (particularly stomach and gall-bladder) ? mental health problems ? addictions ? ageing problems.
Furthermore, there is general agreement that people with intellectual disability do not use and engage fully in:
? health education/information ? health promotion programmes, such as those for healthy eating, weight reduction, physical activity, and exercise classes ? health screening programmes, including health checks, Helicobacter pylori screening, sexual health (for example, contraception), women’s health (for example, breast and cervical cancer screening), men’s health (for example, testicular cancer screening), and dementia screening.
The Health Special Interest Research Group of the International Association for the Scientific Study of Intellectual Disability (IASSID) met in 1999 under the auspices of the WHO to develop a consensus on health targets and recommendations for people with intellectual disability (see Web Resources).
Key determinants of health inequalities
According to Emerson (2011), there are five key determinants of health inequalities affecting people with intellectual disabilities:
1. Greater risk of exposure to social determinants of poorer health such as poverty, poor hous- ing, unemployment and social disconnectedness. 2. Increased risk of health problems associated with specific genetic, biological, and environ- mental causes of intellectual disabilities.
I 0 The health promotion needs of people with intellectual disabilities
3. Communication difficulties and reduced health literacy. 4. Personal health risks and behaviours such as poor diet and lack of exercise. 5. Deficiencies relating to access to healthcare provision.
Specific health issues in people with intellectual disability
Sensory problems (including vision, hearing, and oral health)
Research shows clearly that problems with vision are strongly associated with intellectual disability, and that the prevalence of these problems increases with age Oanicki and Dalton 1998). The condition is under-recognized; it has been shown that the assessment and management of poor vision in this population requires specialized skills (Evenhuis et al. 2001). Having deficiencies in vision when other faculties are already compromised has implications for mobility, learning, and behaviour. Monitoring sight and providing timely intervention is an important aspect of health care in this population (Evenhuis et al. 2009). Intervention not only involves improving the person’s visual capabilities but also ensuring that health professionals are aware of the issues, so that the effect of the visual deficit is minimized by appropriate adjustments to the physical and interpersonal environment (see Chapter 3). Hearing impairments in adults with intellectual disability who are aged SO years and over range from 8 per cent to as many as 28 per cent in those with Down syndrome (van Schrojenstein Lantman-de Valk et al. 1994). There is a wide range of causes, some of which are similar to those in the non-disabled population while others are associated with the underlying aetiology (for example, Down syndrome, congenital rubella). The diagnosis is dependent on the awareness of people with intellectual disability to recognize their hearing impairments, as well as the awareness of those who support them: given the high prevalence there is need for regular hearing checks. As with visual impairments, advice on adjustment to the environment can make a major difference to people with hearing impairments (Meuwese-)ongejeugd et al. 2006) (see Chapter 3). A higher proportion of people with intellectual disability have tooth extractions and filled teeth compared with the general population (Cum ella et al. 2000). Access to regular dental review from an early age and throughout adult life is fundamental to good dental health. Proper dental hygiene in people with intellectual disability is as an important preventative health measure as it is in the wider population (see Chapter 3).
Nutrition
Many people with intellectual disability have less nutritional diets compared with the non- disabled population, and those with more severe and profound disability have higher rates of under-nutrition (Gravestock 2000) (see Chapter 4). The reason for this may be swallowing difficulties or concurrent problems with their gastrointestinal tract. Chronic malnutrition makes an individual vulnerable to infection; it can also compromise skeletal integrity and the resultant muscle weakness will often limit mobility. This is one of the major causes of morbidity and premature death in this population. Services need to monitor the diets and weights of this population and take appropriate action when problems are identified.
Obesity
The underlying problems of poor nutritional diet and inadequate activity and exercise that cause obesity in the non-disabled population, also impact on people with intellectual disability, who have higher rates of obesity (see Chapter 5). Obesity leads to many health problems and also brings with it an increased risk of cardiovascular disease and diabetes. People with intellectual
Health issues for people with intellectual disabilities II
disability have, to a large extent, not received the preventative health messages and programmes that have been directed to the rest of the community, and are thus less informed to make appro- priate food choices. Their relative poverty makes cheaper and accessible sources of calories par- ticularly attractive. People living independently make food choices for themselves, while those in supported settings are often reliant on support staff to make those choices for them. There is evidence that people in supported environments have healthier diets. The challenge for services supporting more independent options is to ensure that the message on diet and exercise gets through to this population.
Diabetes
People with intellectual disabilities are estimated to be three to four times more likely to have diabetes than the non-disabled population (see Chapter 6). Anwar et al. (2004) found that Type 1 diabetes was more prevalent in individuals with Down syndrome than those with other genetic causes of intellectual disability. Young people and adults with intellectual disabilities are more likely to develop Type 2 diabetes as a result of leading a more sedentary lifestyle, undertaking low levels of exercise and consuming high-fat diets, all of which can contribute towards obesity. Like the non-disabled population, people with intellectual disabilities are living longer, thereby making them more susceptible to developing Type 2 diabetes. There is a dearth of studies that have examined the extent to which their diabetes is managed or whether the quality indicators for diabetes care are met (Taggart et al. 2012).
Epilepsy
The prevalence of epilepsy in people with intellectual disability in the literature ranges from 14 to 44 per cent. This variation is associated with the degree of disability, the population, underlying aetiology, research methodology, and accommodation setting (Bowley and Kerr 2000) (see Chapter 7). Management not only includes the use and monitoring of appropriate medication but also the provision of a safe living environment, adjustments in lifestyle, setting appropriate safety standards, skills in the monitoring and reporting of seizures, and established protocols for responding to seizures.
Cardiovascular disease
Coronary heart disease (CHD) is the second largest cause of premature death for people with intellectual disabilities. They are more likely than the general population to have high blood pressure, be overweight or obese, and be inactive, all of which are risk factors for CHD (de Winter et al. 2012) (see Chapter 8).
Respiratory disease
A 25-year follow up of 2369 people with intellectual disability reported that those under 40 years were more than twice as likely to die as a result of a respiratory disease (87 per cent as a result of pneumonia) than the general population (Patja et al. 2000). Higher rates of aspiration pneumo- nia and inhalation of foreign bodies were also observed in this population. The risk of respiratory disease was found to increase with the degree of disability, gastro-oesophageal disease, dysmor- phias in the oral cavity and a range of immunological deficits.
Cancer
Globally, it is estimated that over 12 million people are diagnosed with cancer every year. The global cancer burden doubled in the final 30 years of the twentieth century, and it is estimated that this will double again by 2020 and nearly triple by 2030. Overall, the incidence of cancer
12 The health promotion needs of people with intellectual disabilities
among people with intellectual disabilities has been reported to be lower than that of the gen- eral population (see Chapter 9). Research has shown that nearly half of all cancers in people with intellectual disabilities are gastrointestinal and oesophageal cancers; this may result from a higher incidence of Helicobacter pylori infection. The next main group of cancers is the urogenital cancers (for example, breast and cervical cancers for women, and testicular and prostate cancers for men) (Patja eta!. 2001).
Sexual health
People with intellectual disabilities commonly experience opposition to sexual activity and face difficulties in expressing their sexuality in a safe and healthy way. Those supporting them face complex challenges (see Chapter 10). Lack of acceptance of the sexuality of people with intellectual disabilities has implications for their access to sexuality related health promotion, screening, and health care (Van Schrojenstein Lantman-de Valk et a!. 2002). The key areas in sexual health promotion for this population include: relationship formation; sexual abuse and relationship violence; appropriate sexual behaviour; contraception, sterilization and menstrual management; pregnancy and parenting; and screening in sexual and reproductive health.
Mental health
The prevalence of mental health problems in people with intellectual disability varies depending on the diagnostic criteria and the research methodology. The overwhelming volume of research shows a much higher prevalence of mental health disorders compared with the non-disabled population (see Chapter 11). Cooper eta!. (2007) found double the rate of all mental health prob- lems using the DC-LD (Diagnostic Criteria for Psychiatric Disorders for Use with People with Adults with Learning Disabilities/Mental Retardation; Royal College of Psychiatrists 2001). This study indicated a prevalence of psychotic illness of 4.6 per cent compared with 0.4 per cent in the general population. Cooper and colleagues also showed that 6.6 per cent of people with intel- lectual disability suffered from affective disorders, and 3.6 per cent from anxiety disorders. Social and environmental factors can contribute to the development of mental health disorders in this population. Communication difficulties, social isolation, lack of employment opportunities, loss and grief when carers move on, and limitations in their choice of with whom and where they live are all significant stressors that need to be considered in the prevention and manage- ment of mental health problems.
Addictions
In the non-disabled population, cessation of smoking is one of the most significant preventa- tive health programmes impacting on respiratory disease, cardiovascular health, cancer, and diabetes. Emerson (2005) reported that smoking was more prevalent in people with intellec- tual disability living in the community than those living in supported accommodation. This situation will evolve as public health policies in reference to smoke free environments are being implemented in different countries. A study of 1097 people with intellectual disability found that 17.3 per cent smoked tobacco and that asthma rates in those who smoked was double that of those who did not (Gale eta!. 2009) (see Chapter 12). In a review of 67 substance users with intellectual disability in Northern Ireland, Taggart et a!. (2007) showed that alcohol was the main substance misused; in 20 per cent of cases this was in com- bination with illicit drugs and/or prescribed medication. There was an increased risk of substance abuse among males who were young with borderline/mild intellectual disability, living indepen- dently, and who had mental health problems. Problematic behaviours related to the addiction were also seen as an issue of concern (Taggart eta!. 2006). Research has suggested a need for earlier identification to limit long-established patterns of use and associated behaviours (see Chapter 12).
Health issues for people with intellectual disabilities 13
Ageing
The authors of a critical review of the international literature from 1999 to 2009 that focused on age-related health risks, age-related oral health and lifestyle health risks in older people with intellectual disabilities, reported that cardiovascular disease is as prevalent and as common a cause of death among older people with intellectual disabilities as in the general population (Haveman eta!. 2011). There are, however, variations in prevalence, which are culturally depen- dent: lifestyle health risks included poor nutrition, a lack of exercise, and poor mobility leading to higher obesity levels (Hilgenkamp eta!. 2012) (see Chapter 13). As in the non-disabled popu- lation, healthier lifestyles, improved nutrition and increased exercise, as well as regular health checks to improve surveillance of health risks, are reported as key to improving the health status of older adults with intellectual disabilities (Evenhuis eta!. 2012).
Medication
The efficacy and side-effects of medications used in this population are less reliant on patient reports and more reliant on the observations of others. People with intellectual disability are some of the highest consumers of psychotropic and anti-epileptic medications with high rates of potentially serious side-effects and the potential for significant interactions (McGillicuddy 2006; de Kuijper et a!. 2010). If we are to prevent or minimize iatrogenic disease from medications, people with intellectual disabilities and their carers need to be active participants in both the reporting of outcomes and the observation of side-effects. As some side-effects, such as weight gain associated with certain medications, can be anticipated, active health promotion strategies around diet and exercise need to be put in place from the outset.
Systemic issues
Regular health checks, including physical examinations that include a record of blood pressure, weight, review of dentition, breast or testicular examination, and assessment of vision and hear- ing, should be part of a person’s health management programme (see Chapter 18). Research has shown that when this is done regularly, health problems are identified earlier (Lennox et a!. 2006). While this is becoming a requirement of support services in some jurisdictions, people with intellectual disability who live independently or with their families also need to be aware of the need for regular health checks that focus on their health vulnerabilities.
People with intellectual disabilities and the need for health promotion
Major progress in improving the health of the wider community has come about through pub- lic health measures targeting social disparities and through specific health education, health promotion programmes and health screening initiatives (see Chapter 2). This has proven to be a cost-effective way of tackling the major health problems in the community, especially when targeting chronic diseases. People with intellectual disability have the same right to access these interventions as the non- disabled population (UN 2006). While people with intellectual disability are subject to the same range of major health problems as the general population, research has shown that they have particular vulnerabilities. The health promotional activities commonly used in the non-disabled population may need to be adapted for people with intellectual disability and their carers. Where greater health vulnerabilities have been identified health education, health promotion pro- grammes, and health screening initiatives need to be better targeted.
14 The health promotion needs of people with intellectual disabilities
Summary
The social determinants of health are extremely important for this population and lessons learnt from approaches used in other marginalized groups should be considered. Research and evalu- ation is critical to ensure that interventions achieve the expected outcomes in the most cost- effective manner (see Chapter 20). The challenge in establishing equitable health promotion programmes for people with intellectual disability is an issue in many countries. The need to measure health outcomes and to build new or extend existing partnerships with key stakeholders to improve access to health promotion activities is now widely recognized. Developing and promoting a good evidence base for health promotion activities in this population would help support services achieve better outcomes. Not only do priorities need to be established, it is also important to target interventions appropriately: times of transition, such as leaving school, the start of living independently, moving from the family home, or retirement, provide opportunities for targeted interventions. Better health is a key foundation for better lives in people with intellectual disability.
Useful resources
? Health Inequalities and People with Learning Disabilities in the UK: 2012 (Emerson et al. 2012) summarizes the latest evidence about the extent, nature, and determinants of health inequalities experienced by people with learning disabilities 1n the UK. Available at: http://www .im provingheal thandlives.org. uk/publications/ 1165 /Health_Inequalities_ &_ People_ with_Learning_Disabili ties_in_the_ UK:_ZO 12
Web resources
? Health Guidelines for Adults with an Intellectual Disability, IASSID: www.iassid.org/pdf/ healthguidelines-2002.pdf
? The Improving Health and Lives Learning Disabilities Observatory are here to keep a watch on the health of people with learning disabilities and the health care they receive: www. improvinghealthandlives.org.uk/
? The following site offers fact sheets on common health problems for people with intel- lectual disabilities: www.nswcid.org.au/health/se-health-pages/standard-fact-sheets.html
References
American Association on Intellectual and Developmental Disabilities (AAIDD) (2012) Definition of intellectual disability. Washington, DC: AAIDD. Available at: www.aaidd.org/content_lOO.cfm?naviD=21 [accessed September 2012). Anwar, A., Walker, D. and Frier, B. (2004) Type 1 diabetes mellitus and Down syndrome: prevalence, management and diabetes complications. Diabetic Medicine, 15: 160-63. Bowley, C. and Kerr, M. (2000) Epilepsy and intellectual disability. Journal of Intellectual Disability Research, 44(5): 529-43.
Health issues for people with intellectual disabilities
Cooper, S.A., Smiley, E., Morrison,]., Williamson, A. and Allan, L. (2007) Mental ill-health in adults with intellectual disabilities: prevalence and associated factors. British Journal of Psychiatry, 190(1): 27-35.
IS
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16 The health promotion needs of people with intellectual disabilities
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