LEARNING DISABILITY PRACTICE April 2009 | Volume 12 | Number 3 33
Feature
`We deal with elderly clients in crisis because
their carer has either died or become
physically incapable of looking after them'
older. So you've been through a lot of triumphs
and tragedies together' (focus group 3, community
learning disability nurse).
Specialist model A number of professionals,
such as learning disability nurses, social workers,
physiotherapists, psychologists, speech and
language therapists, occupational therapists,
dieticians and psychiatrists, can be involved in
providing specialist services for people with learning
disabilities (Northway and Jenkins 2007). However,
few specialist services have been developed for
older people with learning disabilities. Jenkins
(2009) provides a positive account of one nursing
home which caters exclusively for older people with
learning disabilities, who may develop dementia
that requires specialist intervention. Individuals with
Down syndrome are particularly prone to developing
Alzheimer's disease, with prevalence rates of 22
per cent for those aged over 40, and 56 per cent for
those aged over 60 (Janicki and Dalton 2000). The
DH (2001a, 2009) advises that learning disability and
generic mental health services should work together
to address this issue. Surprisingly, when specialist
dementia services are available, few, if any, older
people with learning disabilities who have additional
dementia needs appear to be referred to such a
service. Despite this, there seems to be a willingness
to work together to meet clients' complex needs:
`Our expertise is never called upon. Although our
hospital is classed as specialised for dementia, I've
never known a Down syndrome patient come to us,
even for joint working. I find this surprising, to be
honest, because I think we could work well together'
(focus group 4, mental health nurse).
Meeting complex needs requires specialists to work
together, and one way of making this easier is for
them to be based together. There was some support
for basing together different teams, including nurses,
to improve commitment to partnership working.
There is a feeling that being based in different
locations makes the practical aspects of partnership
working more difficult to achieve:
`I suppose, ideally, community teams � mental
health and learning disability � should be based
together. I think that's the way forward. As it
is, they're just two completely separate entities'
(focus group 4, mental health nurse).
There was support for specialist, as well as
generic services, to be developed for older people
with learning disabilities, although it was not clear
what form such a specialist service should take.
Participants felt that older people with learning
disabilities should be able to access both types
of service:
`I think there needs to be a bit of both because
some people are able to access generic services; they
are fine and they can attend, lovely. But I think...
there should be something else' (focus group 1,
community learning disability nurse).
Generic model This model requires older people
with learning disabilities to use generic older
people services. There is support for this approach
as it does not see people with learning disabilities
differently from the general population. However,
there is evidence from Thompson et al (2004)
that when people with learning disabilities use
residential services for older people they encounter
difficulties. The researchers found that they may
not be welcomed by residents in the home, have
few activities to undertake and lose contact with
family and friends. Some generic day services also
seem reluctant to allow access to their day service,
with the label of learning disability appearing to
act as a barrier. Flexibility and an emphasis on
socialising, rather than work, may make such
placements more appealing:
`There should be a menu of things. I have
worked in a team where there was a very
successful day service for the elderly, but it
worked very much on a drop-in basis. There were
gentle activities. It was based more on socialising
than work and it was nice that people had social
contact and kept in touch with friends. There
wasn't an expectation that people had to be there
by 9am and that they had to stay until 4pm. It
was much more kind of appropriate, I suppose,
but we don't have anything that we can offer
people, and generic services are fairly reluctant to
accept referrals for our people because they have
learning disabilities' (focus group 1, community
learning disability nurse).
It is important that nurses view people with
learning disabilities as people first. Here is a good
example from a practice nurse who was able to
see beyond the label of `learning disability' and
witness an individual who had had some success in
integrating into the community:
`She's got a cat. You know, she's just a normal
person; she is so happy that she's actually out and
about, and able to function normally within society'
(focus group 2, practice nurse).

Page 1Page 2Page 3Page 4Page 5Page 6Page 7Page 8Page 9Page 10Page 11Page 12Page 13Page 14Page 15Page 16Page 17Page 18Page 19Page 20Page 21Page 22Page 23Page 24Page 25Page 26Page 27Page 28Page 29Page 30Page 31Page 32Page 33Page 34Page 35Page 36Page 37Page 38Page 39Page 40Page 41Page 42Page 43Page 44 Produced by PageSuite