‘The enjoyment of good health is the key to a good quality of life’ (Thompson and Pickering, 2001)
The Department of Health and Children encourages the promotion of healthy lifestyle choices for all. However, this is not possible unless an individual is able to make informed choices about his/her lifestyle, diet and living environment. This is not an easy option for people with an intellectual disability— some may not be able to make informed choices, others may be poorly informed about choices open to them, and others may not be able to access their preferred option.
Some of the main health concerns people face today are obesity, diabetes, nutrition, dental health and cardiovascular issues.
Evidence suggests that people with an intellectual disability may be at increased risk from obesity. Risks of obesity have been associated with different factors: female gender; less restrictive living environment; living in a family setting; low senior staff ratios; and Down syndrome. The percentage of people with intellectual disabilities who are overweight and obese appears to be higher than in the general population. The sedentary lifestyles of many people with an intellectual disability are seen as another cause of obesity. It has been acknowledged that obesity is a major health problem, as it is linked to a number of diseases, including cardiovascular disease, diabetes, hypertension and various cancers. A significant variation from normal weight and lack of physical exercise are considered major behavioural risks to health among people with an intellectual disability.
Special health screening clinics may contribute to addressing obesity, but they should not be used in isolation. Health promotion classes have been identified as playing a significant part in weight reduction. However, an interdisciplinary, collaborative approach is needed in order to promote more creative/active lifestyles for people with an intellectual disability. There is a need to develop specific programmes around healthy eating activities and exercise and weight loss programmes.
There are two types of diabetes: Type1 — insulin dependent diabetes, and Type 2 — non-insulin dependent diabetes. Diabetes can be developed when the body doesn’t produce enough insulin, without which the body cannot get the energy it needs from food. Without proper management, individuals with diabetes can develop problems with their eyes, feet and weight. Present-day lifestyle factors such as obesity and inactivity have contributed to an increase in the incidence of diabetes. Because obesity and inactivity are prevalent in people with an intellectual disability, there is the perception that diabetes is also prevalent in this population group. A large component of the management of diabetes involves screening and this may prove difficult for people with an intellectual disability.
Nutritional well-being is considered an important factor in maximising growth, maintaining health and improving the quality of life. Nutrition-related health problems, mainly obesity and chronic constipation, are more prevalent in people with an intellectual disability than in the general population. The incidence of dysphagia and gastro-oesophageal reflux disease is high in people with a severe intellectual disability and people with cerebral palsy. Consequently this places them in a high-risk group for severe under-nutrition.
Nutrition-risk screening is recommended for all, but it is not used widely for people with an intellectual disability. A systematic approach to nutrition-risk screening ensures recognition and management of nutritional problems. Individuals who present as persistently underweight or overweight, with eating or drinking problems, chronic constipation or specific medical conditions such as coeliac disease would be considered to be at high risk. Such individuals should be referred to an experienced dietician for a more systematic assessment of their nutritional status.
The poor quality of oral health care for people with intellectual disability has been recognised, and their fear of dental treatment is suggested as one of the main reasons for non-attendance at dental clinics. It has been suggested that people with an intellectual disability are largely unaware of their own dental problems, and decisions have been based on information gleaned from carers/family members.
People with an intellectual disability are especially prone to coronary heart disease. Unfortunately, they do not access GP services as often as the rest of the general population, owing to communication difficulties, low expectations and an inability to express their own needs. Factors contributing to coronary heart disease include obesity, diabetes, physical inactivity, smoking, and hypertension. Reducing the risk of coronary heart disease entails health screening, education on health risks for the individual, staff training in relation to motivating the individual towards weight reduction, and healthier lifestyles.
The way forward!
Having only touched the surface of some health issues in this introductory article, I suggest that coming issues of Frontline should include a ‘health supplement’ to inform people with an intellectual disability and their carers about a broad range of health issues and topics that are important and relevant in promoting healthy lives. The idea of the supplement is to provide the information with easy-to-read text and pictures, encouraging people with an intellectual disability to learn about their own bodies and helping them to have more control over the things that affect their health.
The health supplement will cover pertinent topics, as well as providing advice/tips about accessing services, keeping appointments, questions that might be asked when visiting the doctor or dentist, or advice on what to expect when attending the clinic, hospital or out-patients department for a procedure. Useful links to websites pages will be provided, with opportunities for anyone to provide feedback on the topics discussed.