Mohammed T. Abou-Saleh

LEARNING DISABILITY 625closed because of the declining abilities of the caregiver. With thedeath of remaining carers, the experience of multiple loss mayprecipitate depression as part of the bereavement response 17 .Asmall group home may then provide a substitute for the familyhome. With foresight and planning, some people may stay in theirown home, with up to 24 hours support if needed.THE PERSON WITH MULTIPLE DISABILITIESLearning disability is known to be associated with an increasedprevalence of coexisting diagnoses that also affect life expectancy,with the result that those with multiple disabilities and superimposedproblems of old age are few in number. There arechallenges in management which may require a combination oflearning disability, psychiatric and geriatric expertise. Somehospitals have developed special units to accommodate thissmall group, but new services are community-based and provide amultispecialty and multidisciplinary format. Private and voluntaryagencies have often led the way.DAY CAREAccommodation and care varying from minimal to total are onlypart of the needs to be met. Daily activities and social contactswill need to be provided, and this may be difficult if the person hasrelocated in an area where he/she is not known. Because ofshortage of places in social education centres (the core provisionfor adults with learning disability in the community), adults withlearning disabilities usually retire by 65 years and then have onlythe occasional part-time arrangement in day centres for theelderly, clubs, adult education institutes and religious activities.As the number of elderly people with learning disabilities in thecommunity increases, person-centred approaches to planningindividual arrangements will be more important.COMMUNITY TEAMSMost areas in the UK have multidisciplinary community teamsfor people with learning disabilities and the trend is for thesespecialist staff to facilitate access to assessment and managementwithin mainstream geriatric and psychogeriatric services. Theopportunities of working together are great, thereby ensuring thatdividing lines in health care do not detract from whole-personmedicine.TERMINAL CAREElderly people with learning disabilities may die at home, inoncology or general medical wards or in a hospice. The combinedcommunity services may be needed and include the terminal careteam. Chaplains, moving from long-stay hospitals into ecumenicalteams in the community, may be called to minister, together withcommunity nurses and community team members, to ensure adignified and good death.CONCLUSIONThe majority of elderly people with learning disability now live inthe community and are more likely to outlive their parents andshare the experience of becoming old with the rest of thepopulation. This is an opportunity to meet their several needssuccessfully and not to repeat the errors of segregation that havelittered learning disability services throughout the industrialworld. There is need for more research at a clinical and planninglevel to underpin creative services, and up-to-date knowledgeavailable for those who do the caring and for those who help thecarers.REFERENCES1. DiGiovanni L. The elderly retarded: a little-known group.Gerontologist 1978; 18: 202–66.2. McLoughlin IJ. A study of mortality experiences in a mentalhandicap hospital. Br J Psychiat 1988; 153: 645–9.3. Wolf LC, Wright RE. Changes in life expectancy of mentally retardedpersons in Canadian institutions: a 12 year comparison. J Ment DeficRes 1987; 31: 41–59.4. Carter G, Jancar J. Mortality in the mentally handicapped—a 50 yearsurvey at the Stoke Park Group of Hospitals (1930–1980). J MentDefic Res 1983; 27: 143–56.5. Carter G, Jancar J. Sudden deaths in the mentally handicapped.Psychol Med 1984; 14: 691–5.6. Hollins S, Attard MT, Von Fraunhofer N et al. Mortality in peoplewith learning disability: risks, causes, and death certification findingsin London. Dev Med Child Neurol 1998; 40: 50–6.7. Jancar J, Eastman RD, Carter G. Hypercholesterolaemia in cancerand other causes of death in the mentally handicapped. Br J Psychiat1984; 145: 59–61.8. Reid AH, Aungle PG. Dementia in ageing mental defectives: a clinicalpsychiatric study. J Ment Defic Res 1974; 18: 15–23.9. Cooper S-A. Psychiatric symptoms of dementia among elderly peoplewith learning disabilities. Int J Geriat Psychiat 1997; 12: 662–6.10. Tait D. Mortality and dementia among ageing defectives. J MentDefic Res 1983; 27: 133–42.11. Cooke LB. Hearing loss in ageing mentally handicapped persons.Aust NZ J Dev Disabil 1989; 12: 321–7.12. Linter C. Aspects of ageing in mental handicap. Br J Ment Subnorm1986; 32: 114–18.13. Crayton L, Oliver C, Holland A, Bradbury J, Hall S. Theneuropsychological assessment of age-related cognitive deficits inadults with Down’s syndrome. J Appl Res in Intellectual Disabilities1998; 11: 255–72.14. Cotten PD, Sison GFP, Start S. Comparing elderly mentally retardedand non mentally retarded individuals: Who are they? What are theirneeds? Gerontologist 1981; 21: 359–65.15. Reid AH, Maloney AFJ, Aungle PG. Dementia in ageing mentaldefectives: a clinical and neuropathological study. J Ment Defic Res1978; 22: 233.16. Valuing People: A New Strategy for Learning Disability for the 21stCentury. Department of Health 2001; 49–50.17. Hollins S, Esterhuyzen A. Bereavement and grief in adults withlearning disabilities. Br J Psychiat 1987; 170: 497–501.