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Most urgent intervention - rapid weight loss & known GORD & dysphagia = high concern for oesophageal cancer. Cuypers et al (2025) show cancer often diagnosed at later stage for people with LD and at greater risk of digestive ca when living alone.

Also - safeguarding “mate crime” - Landman 2014

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Main concern: - Potential Constipation

Research :

Marsh and McMeel (2023) state that,

Leading causes of premature death among people with learning disabilities are respiratory disease, cardiovascular disease and gastrointestinal disorders including constipation . In the final report of the Confidential Inquiry into Premature Deaths of People with Learning Disabilities (CIPOLD), noted that the people they had studied had a range of treatable conditions at the time of their death, of which the most commonly reported was constipation (37% of the sample).

Marsh, L. and McMeel, A. (2023) ‘How to support the accurate diagnosis of constipation in people with learning disabilities’, Learning Disability Practice, 27(4). Available at: https://doi.org/10.7748/ldp.2023.e2231.

Recommendations:

Education on Diet i.e, a higher fibre diet, explained in a way Peter would understand.

Education on his medication: Peter states that he does not know what they are for - education on his medication for himself in a manner that Peter would understand

Education on the screenings that he's eligible for - i.e, the screenings explained to Peter in a way he would understand

Medication referral - look at his medication.

Blood tests

Observations during the health screening

Salt referral

Onward counseling and carers' input due to the ongoing financial abuse going on

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Social care in place for support at night for meds and wellbeing check 

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Social care in place for support at night for meds and wellbeing check 

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Nancarrow, T., Rencher, J., Wilcock, M., Bonell, S., Wolke, T. and Shankar, R. (2019) 'Bespoke STOMP training for learning disability teams—Does it work?', British journal of learning disabilities, 47(3), pp. 181–187. Available at: 10.1111/bld.12272.

This study concluded that despite GP’s knowing about STOMP and its mission, it was noted that specialist LD teams should be in charge of determining whether or not a medication is benefiting the individual. It also noted that STOMP training should be delivered to front-line LD nursing teams as they are the ones who are most directly involved in the care and management of the medications of people with learning disabilities and they will recognise the adverse effects of medication changes or alterations better than a doctor who has only met the individual once before.

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Peter's medication needs to be reviewed, by using SIGN (Scottish Intercollegiate Guidelines Network). SIGN guidelines are designed to support safe, effective, and person-centred prescribing. It includes 7 steps to medication review.

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Here is a link to the RDS newsletter for September 2025 - Right Decision Service newsletter - September 2025

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Follow safeguarding protocols to protect Peter from his "friends" as suspected financial abuse reported by his befriender.

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Peter may be struggling with social isolation, depression, and anxiety. Scotland's Core Mental Health Standards will apply to adult secondary services, including psychological therapies and interventions. They emphasize person-centred care, multi-disciplinary collaboration.

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4. Scope of the Core Standards and Engagement

It is our ambition for these standards to be applicable across all mental health services. They will initially apply to Adult Secondary Services, Psychological Therapies and Interventions and services that treat those with an eating disorder.

The standards have been developed based on engagement with people who use and work in adult secondary services, psychological therapies and eating disorder services. They cover common themes which were important to people in all of these areas.

The consultation results for the adult secondary standards showed clear support for standards which applied to all mental health services. We have responded to that feedback by producing these core standards for all mental health services, alongside requirements for specific areas of practice as 'service specifications'. Our ambition is to work with mental health services more widely to explore how the Core Mental Health Standards could apply across a wider range of services.

The majority of the core standards were originally part of the standards for adult secondary mental health services which were published for consultation. However, there were some standards which apply to only adult secondary services, rather than all mental health services. These specific standards are included in Annex B.

The Core Mental Health Standards are informed by the Health and Social Care Standards. They use the principles of the Health and Social Care Standards and apply them in a mental health setting. The Core Mental Health Standards directly reflect what people who use and work in mental health services told us was most important to them.

The diagram below shows the Core Mental Health Standards and their relationship to the Health and Social Care Standards, Mental Health and Wellbeing Strategy and different specifications.

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These core standards support adult secondary services with the aim of improving quality and safety of mental health services for people in Scotland.

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Food chart in place ,bowel scan

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Peter's friend raised a concern that his friend is taking money. Peter struggles to afford to pay bills.

The Care Act 2014 mandates that local authorities must investigate suspected financial abuse.

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Adult social care and support in Scotland

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This briefing describes how adult social care and support operates in Scotland. It includes information on the history, key legislation and policy to help explain the ‘system’ that comprises adult social care and support. It includes data from key sources and a summary of written evidence provided to the Health and Sport Committee’s social care inquiry in 2020.

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Moulster & Griffiths Nursing Model to the nursing process 2019

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Moulster & Griffiths Nursing Model to the nursing process 2019

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MEDICATION REVIEW

Health improvement scotland

Right decision service

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Why?

Kings College London (2021) Learning from Lives and Deaths People with a Learning Disability and Autistic People (LeDeR), www.kcl.ac.uk. Available at: https://www.kcl.ac.uk/research/leder.

White, A; Sheehan, R; Ding, J; Roberts et al examined the 2021 LeDeR and found Dysphasia to be the 5th most common long term heath condition for people who passed away in 2021 at 23%.

Intervention works....

2018 - 16% of LD deaths attributed to aspirational pneumonia.

Improvement of Dysphasia management group formed during LD week 2019.

2021 - number of deaths dropped to 3.1% of all respiratory deaths.

What we will do for Peter...

Address nutritional intake, what does he like to eat? Are there things that he likes that are more malable? Does he need more help at home around food? Can he get a POC? More befriender hours?

Produce easy read docs for him. Perhaps make him a menu, meal plan? Social story?

Refer for blood work? Check levels - iron, calcium etc. Medication review?

Refer to SaLT - swallow assessment? Video fluoroscopy of swallow?

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Nursing Standard, 2023,
Improving access to screening for people with learning disabilities, Marriot et al, (2014).

People with Learning Disability experience poorer health than non disabled peers.

Only 15% of people undergo screening, we know from research that over 60 yr+ general public are affected by triple A.

AAA - Is a bulge or swelling of the Aorta, often asymptomatic and more common in men over 65, critical if it ruptures.

Nursing role: easy to read pamphlets, immediate referral to cardology for abdominal ultrasound.