Reasonable adjustments for people with intellectual disability in acute care: a scoping review of the evidence

Abstract

ObjectivesPeople with intellectual disability are vulnerable in terms of health service provision due to increased comorbidity, higher dependency and cognitive impairment. This review explored the literature to ascertain what reasonable adjustments are evident in acute care to support people with intellectual disability, ensuring they have fair access and utilisation of health services.DesignScoping review.SettingAcute care settings.MethodsFive databases were systematically searched to identify studies that reported on the implementation of reasonable adjustments. Authors worked in pairs to screen studies for inclusion, data were extracted and charted and findings were synthesised according to content and themes.ResultsOf the 7770 records identified, six studies were included in the review. The volume of evidence was influenced by specific inclusion criteria, and only papers that reported on the actual implementation of a reasonable adjustment within an acute care setting were included. Many papers reported on the concept of reasonable adjustment; however, few identified its applications in practice.ConclusionsThe scoping review highlights a lack of research on the practice and implementation of reasonable adjustments within acute care settings. There is a need for increased support, education and the provision of intellectual disability specialists across acute care settings.

Predictors and outcomes of recognition of intellectual disability for adults during hospital admissions: A retrospective data linkage study in NSW, Australia

“…Taken together, our results support previous research on the need for more consistent recognition of intellectual disability when receiving health services [ 11 , 20 ]. Low recognition rates of intellectual disability highlight a major barrier to providing reasonable adjustments in health care settings for people with intellectual disability, particularly for those in contact with the justice system, and those presenting to hospital for reasons related to drug and alcohol use.…”

“…One way to improve the experience of people with intellectual disability as they interact with the health care system is to ensure reasonable adjustments are made during health service contacts [ 10 , 11 ]. Reasonable adjustments are defined as removing barriers to services that may affect people with disability, such as changing the way services are delivered, altering policies or procedures as appropriate, and providing staff with the proper training to meet the service needs of people with disability [ 10 , 12 ], and are mandated during health service contacts in the United Kingdom for people with intellectual disability [ 13 ].…”

“…Reasonable adjustments are defined as removing barriers to services that may affect people with disability, such as changing the way services are delivered, altering policies or procedures as appropriate, and providing staff with the proper training to meet the service needs of people with disability [ 10 , 12 ], and are mandated during health service contacts in the United Kingdom for people with intellectual disability [ 13 ]. A recent metareview into reasonable adjustments in the health care system for people with intellectual disability suggested that changes like preadmission hospital visits, extended consultation times, and access to speciality intellectual disability nurses can substantially improve the quality of care received during an inpatient hospital episode by people with intellectual disability [ 10 , 11 , 14 – 16 ]. However, reasonable adjustments cannot be reliably employed within health service settings unless intellectual disability is identified.…”

“…Such a flag assists identification of the disability, and triggers the need to ask about and document the adjustments required by the person during their contact with the health service. However, research suggests that intellectual disability is not consistently recognised during receipt of health and human services, and that recognition varies according to the sector with which the person has contact, creating an impediment to the uniform application of reasonable adjustments [ 11 , 18 – 21 ]. Though previous research has examined factors that affect the recognition of intellectual disability in children [ 20 ], the factors that determine recognition of intellectual disability for adults during inpatient episodes (and therefore provision of reasonable adjustments) and the impact of this identification on the episode of care have not been identified.…”

Responding to safe care: Healthcare staff experiences caring for a child with intellectual disability in hospital. Implications for practice and training

“…Evidence suggests that staff fail to make ‘reasonable adjustments’ to accommodate their patient's disability because they lack staff training (Disability Royal Commission Australia, 2019; Tuffrey‐Wijne, Goulding, Giatras, et al, 2014). Reasonable adjustments are defined as positive measures that are implemented at individual, departmental or organisational level to address the healthcare inequalities experienced by patients (Moloney et al, 2021). These patients are more likely to be at higher risk of potential or actual harm and have more comorbidities.…”