Learning Disability Health Check

Learning Disability Health Check

Learning disability health assessment

O/E weight - on the accessible letter, we requested those people in a wheelchair

O/E height to bring their height and weight for everyone's convenience

Calculate BMI

O/E BP

O/E Pulse (rate/rhythm)

Urine Test for glucose

As you will note below the next request is for a TSH level, you may therefore consider

arranging a fasting blood test to test for glucose.

TSH level

Thyroid disease is more common in patients with Down's Syndrome. Annual TFTs

are recommended in patients with Down's Syndrome. If you are arranging this test

then consider adding in an FBC, as leukaemia is 10-30 times more common in

patients with Down's Syndrome. I tend to do and FBC, Profile &TFT for all LD pts.

Smoking status

Alcohol consumption

Diet advice

Exercise grading

Change in behaviour

Always consider ear and dental infections

Speech

Ask about any swallowing problems.

There is a useful assessment tool for primary care.

Ask them whether they have regular dental assessments.

Visual

Consider annual ophthalmic assessment in patients with Down's Syndrome and Sturge

Weber Syndrome, glaucoma is a particular problem with Sturge Weber.

Hearing

Consider annual hearing test for patients with patients with Down's Syndrome. The

Community Team for People with Learning Disabilities has very good links with our

local audiologists.

Mobility

Consider osteoporosis and the impact their particular syndrome may have.

Chiropody

Bowels assessment

Gastric cancer is more common in patients with Learning Disabilities. Also consider

the national bowel screening programme, and whether they have received a letter

that they understand, and can act on.

Bladder assessment

If incontinence is an issue, a continence assessment by the district nurses can be very

helpful, it is an important social and psychological issue that can improve quality of

life markedly, along with protecting against skin breakdown.

Epilepsy

Epilepsy is markedly more common in patients with Learning Disabilities, with some

estimates suggesting up to 60% of patients experiencing epileptic seizures. If the

patient has epilepsy, ensure they are on the QOF register, and consider whether they

are on medication such as valproate that would need blood level monitoring.

Mental health

Depression screening is valuable in patients with Learning Disabilities. Dementia is

much more common in patients with Down's Syndrome, and occurs earlier, however

clinical onset is still uncommon before 40 years of age.

Sexual health

Patients with Learning Disabilities may, like anyone else be sexually active, therefore

please do not shy away from this tricky subject. Patients may need contraception

and sexual health advice. A frank web-site that gives access to support in this area is

“Outsiders” and there is a particular link for Learning Disabilities. They are far

more vulnerable to sexual advances, and although the more significant the Learning

Disability, the less likely they are participate intentionally in sexual activity, the more

vulnerable they are to abuse. Safeguarding adults deals with all forms of abuse and

the local information is provided from the County Council – see here for the link.

Breast and testicular awareness

This is a contentious area. There are some that advocate an examination to assess

for abnormalities in all patients with a Learning Disability having. This is on the

reasonable principle that patients with a learning disability may not have capacity to

be adequately aware of what may be abnormal. They therefore should be offered a

breast or testicular examination. There are other people who believe this is an

invasion of privacy too far, and abnormalities should be picked up through the

existing screening programmes, and good education to the carers enabling them to

be aware and noting any visible abnormalities, then referring them to a doctor. I

would suggest you discuss this with the main carer for the patient. Fortunately the

web-site“EASY HEALTH” has videos of breastand testicularexaminations, that the

carer and patient could be guided to, then arranging an appointment with the GP.

Remember to check whether they due for a cervical smear.

Medication Review

As for QOF, every patient on regular medications needs their medication reviewed,

with patients with learning disabilities, particular issues will tend to relate to

epilepsy medication, sedatory and other psychotropic medications. It is notable that

many of the mediations have significant side-effects, and optimising the dosages may

reduce unwanted effects, such as over sedation or weight-gain.

Learning Disabilities Action Plan

Essentially, by the end of the health check there will be issues that need to be

actioned, whether they be for the patient/carer to arrange, or the clinician. Ask them

whether they have a health action plan. I have included a document that can be

either printed out, patient name written, along with actions, and then photocopied

and scanned, or more elegantly I include a document that will merge the patient's

details, that can then be typed into, printed for the patient and then saved into the

patient record. I recognise some training of your staff maybe required to use the

latter option.

Reproduced with agreement of Dr Tom Howesman