What do you expect at your age? In his final article on the Valuing People seminar series, Jon Glasby considers the needs of older people with learning disabilities. (Opinion).

In the early 21st century, a series of medical advances mean that people with learning difficulties are living longer than might once have been expected. Although we do not have accurate data, research and monitoring suggests that average life expectancy has increased from about 20 years in 1930 to around 60 to 64 years for people with Down syndrome and from 70 to 74 years for other people with learning difficulties. While this is a major achievement of which we should be justly proud, it does pose a number of challenges for health and social services:

* There is a growing number of people aged 75 years and over who have particularly high dependency needs.

* Older people with learning difficulties are sometimes placed in generic older people's services where their needs cannot be met appropriately.

* People with Down syndrome are especially prone to the early onset of dementia.

* Services need to be able to respond to the needs of family carers.

* Growing older with a learning difficulty raises issues for palliative care services.

* The life expectancy of people with learning difficulties is still lower than that of the general population and there is widespread evidence of poor health status among people with learning difficulties.

Against this background. 'What do you expect at your age?' was a one-day seminar for health and social care managers and practitioners to consider the needs of older people with a learning difficulty and explore how best to respond. Hosted by the University of Birmingham's Health Services Management Centre. the seminar focused on three themes that re-emerged throughout the various presentations.

PARTNERSHIP WORKING

Developing effective services for older people with learning difficulties depends on the ability to work in partnership with others. Thus health and social care agencies need to work together to produce more coordinated care for service users and their carers, as do generic older people's services and more specialist learning difficulty services.

Partnerships will also need to be developed with palliative care services, who possess a wealth of expertise but who have not always been able to provide appropriate services for people with learning difficulties. Above all, however, services need to work in partnership with users and with carers to ensure that people with learning difficulties are able to maintain their social and family networks as they grow older and do not become isolated by formal services.

SERVICE PROVISION

Specialist learning difficulty services have a key role to play in making sure that older people with learning difficulties are not placed in generic older people's services without access to appropriate support and expertise. Developing high quality services also depends upon the flexibility to respond to changing needs as people age and the ability to take a long-term view, planning ahead to meet predictable age-related needs.

VALUES AND ATTITUDES

Above all, however, responding to the needs of older people with learning difficulties depends on the values and attitudes of frontline staff. Throughout the seminar, speakers emphasised that every older person with learning difficulties is an individual in his or her own right with the same rights and needs as everyone else, This was particularly captured in a quote from one of the speakers. who said: 'The way in which we practise health care is the means by which we demonstrate the value we place on people's lives.'

As a result, the challenge for practitioners and managers working with older people with learning difficulties is to play their part in demonstrating the value they place on the needs and lives of the people with whom they work.

For further information, see Today and Tomorrow: The report of the growing older with learning disabilities programme. Details are available from the Foundation for People with Learning Disabilities website at www.learningdisabilities.org.uk

Jon Glasby BA, MN/DipSW, PhD is a lecturer at the Health Services Management Centre, University of Birmingham

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