Clinical Review

Managing health problems in people with intellectual disabilities

BMJ 2008; 337 doi: http://dx.doi.org/10.1136/bmj.a2507 (Published 08 December 2008) Cite this as: BMJ 2008;337:a2507
  1. Henny M J van Schrojenstein Lantman-de Valk, assistant professor1, physician for persons with intellectual disabilities 2,
  2. Patricia Noonan Walsh, National Disability Authority professor of disability studies 3
  1. 1Department of General Practice and Governor Kremers Centre, Maastricht University, PO Box 616, 6200 MD Maastricht, Netherlands
  2. 2Pepijn and Paulus Centre, PO Box 40, 6100AA Echt, Netherlands
  3. 3Centre for Disability Studies (School of Psychology), University College Dublin, Dublin, Ireland
  1. Correspondence to: H M J van Schrojenstein Lantman-de Valk henny.lantman{at}hag.unimaas.nl

    Summary points

    • People with intellectual disabilities have twice as many health problems as the general population

    • The medical history should be obtained as far as possible from the patient; otherwise an accompanying person should complete it

    • Pictures, gestures, and body language are useful for communicating with the patient

    • The excess morbidity is related to the disabilities (such as epilepsy, mobility problems, sensory deficits), is syndrome related (such as related to hypothyroidism in people with Down’s syndrome), or is secondary (such as obesity and reflux disease)

    • Accessible health promotion materials are scarce

    People with intellectual disabilities have a higher prevalence of health problems than the general public, and their health needs are often unrecognised and unmet.1 People with intellectual and other disabilities are also more likely to develop secondary health conditions.w1 Improving the health of people with disabilities during their lives is a specific aim of the Healthy People 2010 initiative in the United States,2 the Valuing People initiative in the United Kingdom,w2 and the Pomona project (www.pomonaproject.org),3 a public health initiative funded by the European Union to develop and test a set of health indicators for people with disabilities.

    A recent randomised controlled trial on annual health screening in people with intellectual disabilities found an improvement in health in the intervention group.4 Nevertheless, epidemiological research on the health of people with intellectual disabilities is limited. We present here an up-to-date overview for medical generalists.

    What is intellectual disability and how common is it?

    Epidemiological research shows a prevalence of intellectual disability of about 0.7% (a figure mostly derived from service registrations—funding bodies or service providers).5 w3

    In a recent conceptual review, Mont challenges the usefulness of a single summary indicator to capture disability,6 which is not a health condition borne by an individual. Rather, disability is, he says, “complex and multifaceted, with …

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