People with learning disabilities are more likely to die prematurely, inquiry findsBMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f1853 (Published 20 March 2013) Cite this as: BMJ 2013;346:f1853
All rapid responses
I read with interest the published findings of Fleming et al (1) and would like to highlight the impact that poor vision may have on health. The report states that over fifty percent of those who died prematurely had visual problems (1).
Within the report, researchers attributed premature death to problems with identifying needs and providing appropriate care in response to changing needs. Loss of vision often results in a change in behaviour and is often overlooked or misattributed through diagnostic overshadowing. One in ten adults with learning disability have severe visual impairment (2). With such a high percentage of patients affected by visual problems, improving access to eye care both in the community and in secondary care, should be a priority area.
The authors also note that a lack of reasonable adjustments to facilitate healthcare and attendance at out patient clinics was a contributory factor. Health Care for All acknowledged that reasonable adjustments “are not particularly difficult to make” (3) and a list of such adjustments for eye clinics has been published (4).
The first step in improving elective health care is to enable healthcare providers to know the patient has learning disability prior to the appointment in order to facilitate communication with the patient and carer about the type of adjustments which might be appropriate. Their proposal to recommend national flagging of learning disability on NHS IT systems would improve this situation and should be seen as a critical step in reducing inequalities in healthcare for people with learning disability.
1Heslop P, Blair P, Fleming P, Hoghton M, Marriott A, Russ L. Confidential inquiry into premature deaths of people with learning disabilities (CIPOLD): final report. Mar 2013.
2 Robertson J, Emerson E. Estimated prevalence of visual impairment among people with learning disability in the UK. Improving Health and Lives. Department of Health 2011.
3 Michael J. Healthcare for All Department of Health 2008.
4 Turner S, Kill S, Emerson E. Making Reasonable Adjustments to Eye Care Services for People with Learning Disabilities. Improving Health and Lives. Department of Health. 2013
Competing interests: Chairman of Vision 2020 Learning Disability SubCommittee