Journal of Community Nursing - page 79

JCN
2013,Vol 27, No 4
79
LEARNING DISABILITIES
L
earning disability is defined
as a significantly reduced
ability to understand new or
complex information, to learn new
skills, and to cope independently
(Department of Health [DH], 2001).
It usually appears before adulthood
and significantly impairs the
individual’s development. The DH
estimates that 1.2 million people
in England have mild or moderate
learning disabilities and 210,000
people have severe or profound
learning disabilities, which are
most commonly caused by Down’s
syndrome and cerebral palsy (DH,
2001; Emerson and Hatton, 2008).
Consequently, the average GP
will have approximately 40 patients
with learning disabilities on his or
her caseload, a patient group that is
known to have a higher incidence
of health problems than the general
population (DH, 2001). Using data
from general speech and language
therapy caseloads, it is estimated
that approximately 36% of patients
Managing swallowing difficulties in
patients with learning disabilities
with learning disabilities in primary
care have swallowing difficulties
(Leslie et al, 2009).
THE IMPACT OF DYSPHAGIA
While the swallowing function is
necessary for the ingestion of fluid
and food, meals and coffee breaks
provide the focus for much of our
social interaction. Consequently, any
condition that affects the ability to
swallow or provides embarrassment
when eating and drinking can
significantly affect an individual’s
quality of life.
An inability to sufficiently
masticate and lubricate a bolus
before swallowing can increase
the likelihood of choking, while
conditions that impair closure of
the epiglottis (which prevents food
or liquids from entering the lungs
during the act of swallowing) (
Figure
1
), can increase the likelihood of
aspiration pneumonia.
In certain diseases that cause
dysphagia, such as Parkinson’s
disease, aspiration pneumonia is the
main cause of death (Wermuth et al,
1995). It is unsurprising, therefore,
that the National Patient Safety
Agency (NPSA) has identified
dysphagia as a key area of risk for this
population group (NPSA, 2007).
Managing swallowing
difficulties appropriately can
improve patients’wellbeing
through appropriate nutrition and
hydration, ensuring they receive
their prescribed medication and
preventing adverse events such as
choking and aspiration pneumonia.
Consequently, it is important that
community nurses assess patients
with learning disabilities for risk of
swallowing difficulties and, where
these are identified, put appropriate
interventions in place to improve
patient care.
IDENTIFYING THE CAUSE
OF DYSPHAGIA IN PATIENTS
WITH LEARNING DISABILITIES
Speech and language therapists
specialising in the evaluation and
management of dysphagia divide the
swallowing process into three phases:
Oral
Pharyngeal
Oesophageal.
This enables the location of the
anatomical problem to be accurately
described (
Figure 2
) (Wright, 2011).
David Wright, Professor of Pharmacy Practice,
School of Pharmacy, University of East Anglia,
Norwich; Tom Howseman, GP and Clinical
Director of LD Commissioning, Nene and
Corby CCG, St Luke’s Primary Care Centre,
Northampton
In 2012 a national working party consisting of experts in the
care of patients with learning disabilities and the management
of swallowing difficulties (dysphagia) was convened to develop
guidelines to assist with the identification of at-risk patients. The aim
was to improve the diagnosis and management of dysphagia in this
patient population. The guidelines were also designed to improve
the protection of such patients by ensuring that they are treated in a
fair and equitable manner. This article provides an overview of the
guidelines (Wright et al, 2012) for the community nurse.
KEYWORDS:
Learning disabilities
Dysphagia
Medication
Guidelines
Figure 1.
The physiology of swallowing.
Nasal cavity
Palate
Tongue
Jaw
Oral cavity
Pharynx
Epiglottis
Oesophagus
Larynx
Larynx opening
into pharynx
David Wright, Tom Howseman
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