Health Matters!

by Aidan Butler, Staff Nurse, Stewarts Hospital Services Ltd,

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Health is sometimes taken for granted. It’s not until we become ill or don’t feel quite right that we focus on what is wrong with our health. Fortunately there is a great deal that we can do. We are in a position to improve our health and we usually don’t have to rely on others to do so.

We may go to the doctor, pharmacist or other healthcare professional or use complementary therapies. The choice is always ours. If we have a predisposition to developing certain illnesses we can act accordingly and take the necessary steps to minimise the effects of the illnesses. If we are in pain we don’t suffer in silence. Persons with an intellectual disability (ID) may not communicate verbally. They may be dependent on their
carers to convey their wants and needs. Zwakhalen, Van Dongen, Hamers and Abu-Saad, (2004) assert that assessing pain can be problematic in persons who present with a severe or profound ID. In this instance the gold standard of pain measurement—self-report—is not appropriate. It has been stated that persons with an ID may experience 2.5 times more health problems that the generic population (Van Schrojenstein Lantman-De Valk et al. 2000). Evidence clearly indicates that the physical health and wellbeing of persons
with an ID has not been promoted to the same degree as those without an ID (Marshall, McConkey and Moore 2003).

Walmsley (2004) states that persons with an ID are considerably disadvantaged in a number of ways:
1. Weight
Valuing people (Department of Health (DH) 2001) states that good health is an essential prerequisite for achieving independence, choice and inclusion. It is noted that persons with an ID are more likely to die younger and to live with physical ill health when compared to persons without an ID. Following health checks in Wales (DH 2002) it was noted that persons with an ID were prone to be diabetic and obese. The figure for obesity stood at 35% (40% for women) for persons with an ID, in contrast to 22% for the general population; for diabetes 9% of persons with an ID compared with 4% or less in the general population. Drugs such as Amisulpride, Olanzapine, Quetiapine and Risperidone are known to trigger an increase in weight (Allison, Mentore and Heo, 1999). Furthermore 25-50% of persons with an ID who reside in institutions are prescribed neuroleptic [tranquilising] medication (Kiernan et al. 1995).

2. Vision
Cataracts often appear early in persons with Down Syndrome. The International Association of the Scientific Study of Intellectual Disability (IASSID) recommends that adults with an ID should be assessed for acuity, near vision, pressures and visual fields from at least 45 years of age and checked every 5 years thereafter. Persons with Down Syndrome should be checked from the age of 30 for cataracts, keratoconus and diabetic retinopathy. Regular clinical examinations would aid in the prevention of unnecessary visual impairments.

3. Hearing
Persons with an ID have higher levels of impaired hearing in contrast with the general population (Welsh Health Survey 1995). Yeats (1991) acknowledges that hearing loss is far greater in persons with an ID: 37% in comparison to 14% of those without an ID. Mencap (1998) emphasise that general practitioners are unsure as to when a hearing assessment is necessary and frequently disregard carers’ concerns. Audiologists recommend that people with an ID, particularly children, should receive a regular hearing assessment every two years, especially for those deemed to be at risk (Roberts 2005).

4 .Oral health
Local and regional studies in America demonstrate that persons with an ID and developmental disabilities have considerably higher rates of poor oral hygiene and periodontal disease than the general population. In the most recent study of children with an ID, 8% of these children who required dental treatment did not receive this service. Under the auspices of Special Olympics (America) graduates of dental schools must have sufficient skills to determine the dental treatment needs of persons with special needs (Waldman and Perlman, 2005).

5. Gastroesophageal reflux disease
In a study of 435 residents with gastroesophageal reflux disease living in institutionalised accommodation the following probable predisposing factors were offered to explain the occurrence of the disease in this cohort: nonambulancy, scoliosis, cerebral palsy, the use of anticonvulsant therapy and having a severe intellectual disability. Some of the symptoms were: persistent vomiting, hematemesis, (vomiting blood) rumination, regurgitation, food refusal and recurrent pneumonia. Persons who engage in rumination not only ruminate food but also gastric fluid inducing oesophageal damage (BŒhmer et al. 1999).

6. Mental health
In comparison to younger adults, older people who present with an ID are more susceptible to have mental health problems, especially depression, anxiety and dementia (Cooper 1997). This fact has been attributed to social, biological and medical factors, life events and specific syndromes (Tyrell and Dodd 2003). People with Down Syndrome are at an exceptionally high risk of developing dementia, with the age of onset 30-40 years younger than the general population (Holland et al. 1998).

Conclusion

It is known that obesity is a major health risk. It is associated with several diseases including cardiovascular disease, diabetes, hypertension and various cancers. Unfortunately even when a person with an ID is deemed to be overweight or obese there is no guarantee that appropriate steps will be taken to control the person’s weight (Marshall, McConkey and Moore 2003). Health promotion for persons with an ID should be pro-active rather than crisis- driven (Carlson 2002). There is a correlation between physical and mental health problems and challenging behaviours. Therefore is it imperative that these health issues are diagnosed and treated appropriately (Twist and Montgomery 2005).

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