Supporting Adults with Learning Disabilities in the Peri-operative Setting: Key Considerations for Anaesthetists

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Paul Au

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Supporting Adults with Learning Disabilities in the Peri-operative Setting: Key Considerations for Anaesthetists – ATOTW 555

20 January 2026

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1) The National Institute for Health and Care Excellence ( NICE ) defines learning disabilities by four core criteria.

True False

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NICE defines learning disabilities based on three core criteria : lower intellectual ability (usually an IQ of less than 70), significant impairment of social or adaptive functioning and onset in childhood.

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2) Most individuals with mild learning disabilities can manage basic self-care and practical activities, they can live and work relatively independently, but may require appropriate support.

True False

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Underdiagnosis is common in this patient group and their additional needs may sometimes be overlooked.

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3) All patients with learning disabilities lack mental capacity to consent for treatment.

True False

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Patients with learning disabilities are impacted differently at variable severity which could affect their ability to make treatment decisions for themselves. Some patients may be able to consent for a simple procedure but lack capacity to process information for more complex and major surgeries.

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4) Individuals with learning disabilities have a shorter life expectancy compared to the general population.

True False

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This patient group often experience poorer health outcomes, which can be attributed to various factors. These may include unequal access to health services and disconnection between primary and secondary healthcare teams, leading to delayed diagnosis and treatment.

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5) Communication barriers pose a significant challenge for healthcare professionals when treating patients with learning disabilities.

True False

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Many adults with learning disabilities experience difficulties not only in comprehension, but also in expressing of their thoughts especially those who are minimally verbal or non-verbal.

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6) Challenging behaviour may be a form of communication.

True False

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Presenting for surgery is a stressful process for patients with learning disabilities, exposing them to an unfamiliar environment and personnel. This can sometimes lead to challenging behaviours, especially for those who are minimally verbal or non-verbal, as a means to communicate physical and mental discomfort.

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7) Patients with learning disabilities are unlikely to have multiple primary and secondary health conditions.

True False

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Coronary heart disease and cancer are among the leading causes of death within this group. Learning disability is associated with genetic syndromes like Down syndrome and Williams syndrome. Patients with learning disabilities are more likely to be overweight, have poor oral health and suffer from gastrointestinal reflux and constipation.

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8) Patients with learning disabilities are often polymedicated, especially with psychotropic medication.

True False

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Individuals with learning disabilities are at a higher risk of mental health illness and more likely to take psychotropic medication. Public Health England states that everyday about 30000 to 35000 adults with learning disabilities are taking psychotropic drugs.

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9) Only the surgical team is responsible in planning surgical treatment for patients with learning disabilities.

True False

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A multidisciplinary team approach is warranted to address the complex health needs of patients with learning disabilities. This often involves healthcare professionals, care givers and support networks from primary and secondary care.

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10) Healthcare providers should make changes to their service delivery to ensure that people with learning disabilities do not face disadvantages in accessing healthcare services.

True False

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These changes are termed reasonable adjustments. In the UK, healthcare providers have a legal duty to make reasonable adjustments to their care provision to ensure that services are as accessible to people with disabilities as they are for everyone else under the Equality Act 2010.

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11) Lack of implementation of reasonable adjustments can result in treatment failure and cancellation of surgery.

True False

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Failure to implement reasonable adjustments also creates undue stress for patients and carers, resulting in subpar healthcare experiences that could deter them from seeking medical attention in the future.

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12) All patients with learning disabilities need a best interest meeting about decision for surgery.

True False

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Only patients who lack mental capacity need a best interest meeting. It is vital to ensure that views of patients are represented, taking into account perspectives from their family, close friends, advocates, carers and community team, in addition to specialist opinions from clinical teams.

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13) All patients with learning disabilities need a planning meeting about hospital admission.

True False

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It is advisable to convene a multidisciplinary team meeting to discuss patient’s reasonable adjustments in anticipation of surgical treatment and hospitalization. Patients with varying degrees of learning disabilities and undergoing different surgical procedures require individualised plans tailored to their specific needs and the complexity of their surgery.

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14) Hospital passport serves as a valuable tool for healthcare professionals in effectively caring for patients with learning disabilities during their hospital stay.

True False

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Hospital passport is a document designed to provide essential information about patients with learning disabilities, which include details such as their communication preferences, sensory needs, behavioural triggers and other reasonable adjustments in addition to medical history. The passport is personalised to the individual, patients and their carers are encouraged to bring it in with them during all hospital visits.

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15) Pre-operative hospital walks and visual aids such as virtual tour and photos of clinical areas can help alleviate stress and anxiety associated with attending for surgery.

True False

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Familiarising patients with the hospital environment before surgery can significantly reduce anxiety and stress associated with hospital admission.

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16) Sedative premedication should not be given to patients with learning disabilities because it may interact with their psychotropic medication.

True False

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Sedative premedication may be necessary, particularly for patients with a history of traumatic healthcare experiences and challenging behaviour. Careful dosing is essential for those who are on regular psychotropic medication to ensure safe and effective management of anxiety and agitation during pre-operative period.

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17) Only oral premedication should be given to patients with learning disabilities.

True False

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Some patients may not tolerate oral medications, for various reasons such as the bitter taste of oral midazolam. Alternatives may be considered, such as dexmedetomidine, which can be administered intranasally.

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18) Restrictive interventions should never be used if patients exhibit challenging behaviour.

True False

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Restrictive interventions should only be considered as a last resort in situations where there is an imminent risk of harm to patient or others, should be applied with minimal force necessary and in accordance with established guidelines and regulations. All preventive measures should be thoroughly discussed during planning meeting and implemented to mitigate the risk of challenging behaviour in the operating theatre.

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19) Epidural and nerve catheters should never be used in managing post-operative pain for patients with learning disabilities to avoid dislodgement.

True False

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A multimodal analgesic regime including regional anaesthesia should be considered for post-operative pain management for patients with learning disabilities. While there is a risk of dislodgement, epidural and nerve catheters can still be utilised if appropriate precautions are taken to minimise the risk.

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20) Modified assessment tools can be used to assess post-operative pain in patients with learning disabilities.

True False

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Inadequate analgesia is one of the causes of challenging behaviour during post-operative period. Examples of modified assessment tools are Wong Baker’s FACES pain rating scale and Non Communicating Adults Pain Checklist (NCAPC).

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