CQC inspection reports for acute NHS trusts:Are there relationships between the comments in inspection reports regarding people with learning disabilities and CQC hospital/trust ratings?

Purpose - People with learning disabilities are at risk of poor health and premature death. Due to these inequalities, NHS trusts are required to make reasonable adjustments to their care, such as longer appointment times, with the legal duty on them being “anticipatory”. The paper aims to discuss these issues. Design/methodology/approach - Secondary analysis of CQC acute hospital inspection reports asking the following research questions: Do CQC inspection reports mention people with learning disabilities? Where issues concerning people with learning disabilities are reported in CQC hospital inspection reports, what issues and reasonable adjustments are reported? Are there any relationships between comments made in the inspection reports and CQC ratings of the trusts? Findings - In total, 29 of the 30 trust-wide inspection reports (97 per cent) and 58 of the 61 specific site reports (95 per cent) included at least one mention of people with learning disability/ies. Most comments about practices for people with learning disabilities were positive across all CQC inspection output types and across all CQC overall ratings, although the proportion of positive comments decreased and the proportion of negative comments increased as CQC ratings became less positive. Research limitations/implications - Overall the authors found that CQC inspection reports routinely contained some information regarding how well the hospitals were working for people with learning disabilities. The depth of information in reports varied across trusts, with the potential for CQC reports to more consistently report information collected during inspections. Originality/value - The report updates and extends a report published by the Public Health England Learning Disabilities Observatory in 2015

The impact of health checks for people with intellectual disabilities:an updated systematic review of evidence

Health checks for people with intellectual disabilities have been recommended as one component of international health policy responses to the poorer health of people with intellectual disabilities. This review updates a previously published review summarising evidence on the impact of health checks on the health and well-being of people with intellectual disabilities. Electronic literature searches and email contacts were used to identify literature relevant to the impact of health checks for people with intellectual disabilities published from 1989 to 2013. Forty-eight publications were identified, of which eight articles and two reports were newly identified and not included in the previous review. These involved checking the health of people with intellectual disabilities from a range of countries including a full range of people with intellectual disabilities. Health checks consistently led to detection of unmet health needs and targeted actions to address health needs. Health checks also had the potential to increase knowledge of the health needs of people with intellectual disabilities amongst health professionals and support staff, and to identify gaps in health services. Health checks are effective in identifying previously unrecognised health needs, including life threatening conditions. Future research should consider strategies for optimising the cost effectiveness or efficiency of health checks

Systematic reviews of the health or health care of people with intellectual disabilities:a systematic review to identify gaps in the evidence base

Background Systematic reviews are important in evaluating evidence concerning the health of people with intellectual disabilities. This study conducts a systematic review to identify strengths and gaps in this evidence. Method Electronic literature searches and email requests identified systematic reviews published in English from 2008 to 2013 on the health or health care of people with intellectual disabilities. Reviews were categorized using ICD-10 chapter headings and information extracted regarding methods, number of studies reviewed and findings. Results Ninety-four reviews were identified: 52 related to ICD-10 Chapter V: Mental or behavioural disorders, 28 to Chapter XXI: Factors influencing health status and contact with services, and 14 related to other chapters or encompassed multiple chapters. Nine reviews were empty'. No reviews were found for many ICD-10 chapter headings. Conclusions Systematic reviews are heavily weighted towards mental health, with little coverage of several areas important to the health and mortality of people with intellectual disabilities

Perceptions of neighbourhood quality, social and civic participation and the self rated health of British adults with intellectual disability:cross sectional study

BACKGROUND: There is extensive evidence from research undertaken on general population samples that people who have more extensive and closer social networks and people who report feeling connected to their local community tend to have better health. However, relatively few studies have examined the relationship between the social connectedness of people with intellectual disabilities and their health. METHODS: Secondary analysis of data from Understanding Society, a new longitudinal study focusing on the life experiences of UK citizens. We identified 279 participants aged 16-49 (1.1% of the unweighted age-restricted sample) as having intellectual disability, and 22,927 as not having intellectual disability. Multivariate logistic regression was used to investigate between group differences adjusting for potential confounding personal characteristics (e.g., gender). RESULTS: British adults with intellectual disability had less favorable perceptions of important neighborhood characteristics and lower levels of social and civic participation than their non-disabled peers. Favorable perceptions of important neighborhood characteristics and higher levels of social and civic participation were associated with more positive self-rated health for adults with and without intellectual disability. For adults with intellectual disability this was particularly the case with regard to employment, feeling safe outside in the dark and being able to access services when needed. The between-group differences in perceptions of important neighborhood characteristics and levels of social and civic participation accounted for a significant proportion of the elevated risk for poorer self-rated health observed among adults with intellectual disability. CONCLUSIONS: This study provides evidence to suggest that the health inequalities experienced by people with intellectual disabilities may be partially attributable to their less favorable perceptions of important neighborhood characteristics and lower levels of social and civic participation

Mortality in people with intellectual disabilities and epilepsy:a systematic review

Purpose: Epilepsy is highly prevalent in people with intellectual disabilities and mortality is increased in people with epilepsy generally. This review summarises research on the comparative risk of mortality in people with intellectual disabilities and epilepsy compared to the general population, people with intellectual disabilities without epilepsy, and people with epilepsy without intellectual disabilities. Method: Studies were identified via electronic searches using Medline, Cinahl and PsycINFO and cross-citations. Information extracted from studies was tabulated and reviewed narratively. Results: Sixteen studies met the inclusion criteria. Epilepsy was associated with increased mortality in people with intellectual disabilities in most studies, particularly in those experiencing recent seizures. Further research is needed to substantiate some of the reported findings. Conclusion: Services must be equipped with the skills and information needed to manage this condition in order to minimise the risk of death in people with intellectual disabilities and epilepsy. (C) 2015 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved

Prevalence of epilepsy among people with intellectual disabilities:a systematic review

Purpose: Epilepsy is more common in people with intellectual disabilities than in the general population. However, reported prevalence rates vary widely between studies. This systematic review aimed to provide a summary of prevalence studies and estimates of prevalence based on meta-analyses. Method: Studies were identified via electronic searches using Medline, Cinahl and PsycINFO and cross-citations. Information extracted from studies was tabulated. Prevalence rate estimates were pooled using random effects meta-analyses and subgroup analyses were conducted. Results: A total of 48 studies were included in the tabulation and 46 studies were included in meta-analyses. In general samples of people with intellectual disabilities, the pooled estimate from 38 studies was 22.2% (95% CI 19.6-25.1). Prevalence increased with increasing level of intellectual disability. For samples of people with Down syndrome, the pooled estimate from data in 13 studies was 12.4% (95% CI 9.1-16.7), decreasing to 10.3% (95% CI 8.4-12.6) following removal of two studies focusing on older people. Prevalence increased with age in people with Down syndrome and was particularly prevalent in those with Alzheimer's/dementia. Conclusion: Epilepsy is highly prevalent in people with intellectual disabilities. Services must be equipped with the skills and information needed to manage this condition. (C) 2015 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved

People with intellectual disabilities and dysphagia

Purpose: Dysphagia (difficulties in eating, drinking or swallowing) is associated with serious health complications and psychosocial sequelae. This review aims to summarise the state of the evidence regarding dysphagia in people with intellectual disabilities (excluding prevalence), identify gaps in the evidence base and highlight future research priorities. Method: Studies published from 1 January 1990 to 19 July 2016 were identified using Medline, Cinahl, PsycINFO, Web of Science, email requests and cross citations. Studies were reviewed narratively in relation to identified themes. Results: A total of 35 studies were included in the review. Themes identified were as follows: health conditions associated with dysphagia; mortality; health service use; practice and knowledge in supporting people with intellectual disabilities and dysphagia; intervention effectiveness and quality of life. Dysphagia is associated with respiratory infections and choking and may be under-recognised. Silent aspiration is common and may go unnoticed. Management practices exist, but there are few intervention studies and no randomised controlled trials (RCTs), and hence, the effectiveness of these is currently unclear. Conclusion: Dysphagia is a key concern in relation to people with intellectual disabilities. There is urgent need for research on the management of dysphagia in people with intellectual disabilities, including mealtime support offered, positioning, dietary modification and impact on wellbeing

Prevalence of constipation in people with intellectual disabilities:a systematic review

Background. Constipation can lead to serious health issues and death. This systematic review summarises international research pertaining to the prevalence of constipation in people with intellectual disability. Method. Studies published from 1990 to January 2016 were identified using Medline, Cinahl, PsycINFO, Web of Science, email requests, and cross-citations. Studies were reviewed narratively. Results. 31 studies were identified. Constipation rates of 50% or more were reported in 14 studies; 21 studies reported rates over 33%. Based on the most representative study, over 25% of people with intellectual disability received a repeat prescription for laxatives in one year, compared to 0.1% of people without intellectual disability. Constipation was more common in those with cerebral palsy and profound intellectual disability, and associated with immobility but not age. Conclusion. Constipation is a significant issue for people with intellectual disability across the life course and should be actively considered as a diagnosis in this population

Obesity in British children with and without intellectual disability:cohort study

Background Reducing the prevalence of and inequities in the distribution of child obesity will require developing interventions that are sensitive to the situation of ‘high risk’ groups of children. Children with intellectual disability appear to be one such group. We aimed to estimate the prevalence of obesity in children with and without intellectual disability in a longitudinal representative sample of British children and identify risk factors associated with obesity at age 11. Methods Information was collected on a nationally representative sample of over 18,000 at ages 9 months, 3, 5, 7 and 11 years. We used UK 1990 gender-specific growth reference charts and the LMS Growth programme to identify age and gender-specific overweight and obesity BMI thresholds for each child at ages five, seven and eleven years. Results Children with intellectual disabilities were significantly more likely than other children to be obese at ages five (OR=1.32[1.03-1.68]), seven (OR=1.39[1.05-1.83]) and eleven (OR=1.68[1.39-2.03]). At ages five and seven increased risk of obesity among children with intellectual disabilities was only apparent among boys. Among children with intellectual disability risk of obesity at age eleven was associated with persistent maternal obesity, maternal education, child ethnicity and being bullied at age five. Conclusions Children with intellectual disability are a high-risk group for the development of obesity, accounting for 5-6% of all obese children. Interventions to reduce the prevalence and inequities in the distribution of child obesity will need to take account of the specific situation of this group of children

Vaccine Coverage among Children with and without Intellectual Disabilities in the UK:Cross Sectional Study

BACKGROUND: Universal childhood vaccination programmes form a core component of child health policies in most countries, including the UK. Achieving high coverage rates of vaccines is critical for establishing 'herd immunity' and preventing disease outbreaks. Evidence from the UK has identified several groups of children who are at risk of not being fully immunised. Our aim was to determine whether children with intellectual disabilities constitute one such group. METHODS: Secondary analysis of parental report data on child vaccination collected in the UK's Millennium Cohort Study when the children were 9 months, 3 years, 5 years and 14 years old. RESULTS: With one exception (MMR coverage at age 5) vaccination coverage rates were lower for children with intellectual disabilities (when compared to children without intellectual disability) for all vaccinations at all ages. Complete coverage rates were significantly lower for children with intellectual disabilities at ages 9 months (unadjusted PRR non-vaccination = 2.03 (1.14-3.60), p < 0.05) and 3 years (unadjusted PRR = 2.16 (1.06-4.43), p < 0.05), but not at age 5 years (unadjusted PRR = 1.91 (0.67-5.49)). HPV vaccination was lower (but not significantly so) at age 14 (PRR = 1.83 (0.99-3.37), p = 0.054). Adjusting PRRs for between group differences in family socio-economic position and other factors associated with coverage reduced the strength of association between intellectual disability and coverage at all ages. However, incomplete vaccination remained significantly elevated for children with intellectual disabilities at ages 9 months and 3 years. There were no statistically significant differences between parents of children with/without intellectual disability regarding the reasons given for non-vaccination. CONCLUSIONS: Children with intellectual disabilities in the UK are at increased risk of vaccine preventable diseases. This may jeopardise their own health, the health of younger siblings and may also compromise herd immunity