People with a learning disability have worse physical and mental health than people without a learning disability.
On average, the life expectancy of women with a learning disability is 18 years shorter than for women in the general population; and the life expectancy of men with a learning disability is 14 years shorter than for men in the general population (NHS Digital 2017).
Poor quality healthcare causes health inequalities and avoidable deaths
The 2018 Learning Disabilities Mortality Review (LeDeR) found the median age at death was 60 for men and 59 for women, for those (aged 4 and over) who died April 2017 – December 2018. This is significantly less than the median age of death of 83 for men and 86 for women in the general population. This means the difference in median age of death between people with a learning disability (aged 4 and over) and the general population is 23 years for men and 27 years for women.
LeDeR also reported the median age of death for different levels of impairment:
- 62 for people with a mild learning disability
- 63 for people with a moderate learning disability
- 57 for people with a severe learning disability
- 40 for people with profound and multiple learning disabilities
(University of Bristol Norah Fry Centre for Disability Studies, 2019)
Poor quality healthcare causes avoidable deaths
The Confidential Inquiry into premature deaths of people with a learning disability also found that 38% of people with a learning disability died from an avoidable cause, compared to 9% in a comparison population of people without a learning disability (Heslop et al. 2013, p. 92).
The LeDeR found that out of 112 deaths reviewed in a multi-agency review panel, only 19% had been potentially avoidable (University of Bristol Norah Fry Centre for Disability Studies, 2019).
Note: Mencap uses the term 'avoidable death' for deaths that could have been avoided by the provision of good quality healthcare.
Access to healthcare
A number of barriers are stopping people with a learning disability from getting good quality healthcare
These barriers include:
- a lack of accessible transport links
- patients not being identified as having a learning disability
- staff having little understanding about learning disability
- failure to recognise that a person with a learning disability is unwell
- failure to make a correct diagnosis
- anxiety or a lack of confidence for people with a learning disability
- lack of joint working from different care providers
- not enough involvement allowed from carers
- inadequate aftercare or follow-up care
(Heslop et al. 2013; Tuffrey-Wijnes et al. 2013; Allerton and Emerson 2012).
Health promotion initiatives
Annual health checks
55.1% of patients with a learning disability received an annual health check in 2017-18, an increase from 49.7% in 2016/17 (NHS Digital 2019).
44.9% of patients with a learning disability received flu immunisations in 2017/18, a small increase from 41.9% in 2016/17 to (NHS Digital 2019).
In 2017/18, around half (52.5%) of women with a learning disability had been screened for breast cancer, compared to 68% of women without a learning disability. Meanwhile, less than a third (31.2%) of eligible women with a learning disability had received cervical smear tests, in contrast to 73.2% of women with no learning disability. Of those eligible for a colorectal cancer screening, 77.8% of people with a learning disability were screened, compared to 83.7% of those without (NHS Digital, 2019).
Associated health conditions
Common associated health conditions for people with a learning disability include mental health problems, epilepsy, and being underweight or overweight.
In 2017/18 severe mental illness was 8.4 times more prevalent in patients with a learning disability than those without.
In 2017/18, 13.3% of patients with a learning disability had an active diagnosis of depression, compared to 12.2% in 2014/15 (NHS Digital, 2019).
Learn more about mental health in people with a learning disability here.
Research indicates that epilepsy is more prevalent in adults with a learning disability than those without a learning disability; and is more common amongst men and those with a higher level of impairment (McGrother et al. 2006; Epilepsy Society, 2019 ; Robertson et al., 2015). Estimates vary but in a review of 38 studies, the pooled estimate of prevalence of epilepsy in people with a learning disability was 22% (Robertson et al., 2015).
Being underweight or overweight
The proportion of people with a learning disability receiving BMI checks has increased from 58.3% in 2016/17 to 61.5% 2017/18. Of those receiving BMI checks, 6.4% of patients with a recorded learning disability were classified as underweight (BMI ≤ 18.4), this was higher than for those with no recorded learning disability (4.9%). Meanwhile, 37.5% of people with a learning disability were classified as obese, this was also greater than those without a learning disability (29.9%) (NHS Digital, 2019)
The rate of dementia is high in all people with a learning disability, but is particularly high in people with Down’s Syndrome. In 2017/18, the prevalence rate for people with a learning disability aged 55-64 was 4.3%, compared to 0.3% of those with no learning disability. For ages 65-74 it was 5.9% for people with a learning disability, compared to 1.1% for those without. For those aged 75 and over it was 11.2% for people with a learning disability, compared to 8.7% for those without (NIHS Digital, 2019).
A lack of reasonable adjustments can be a barrier to accessing healthcare settings and to equal healthcare (Ali et al., 2013; Heslop et al., 2013). The CIPOLD reviews identified the lack of reasonable adjustments provided to people with a learning disability (especially in accessing clinic appointments and investigations) as a contributory factor in a number of avoidable deaths (Heslop et al., 2013).
Healthcare professionals have a legal duty to provide reasonable adjustments for disabled people (Public Health England, 2016). This can include providing easy-read information, avoiding medical jargon or longer appointment times.
Learn more about reasonable adjustments here.