The term ‘older people with learning disability’ refers to a highly heterogeneous group of people. By definition, they all have delayed or abnormal early development, together with significant intellectual and functional impairments, but they differ considerably in terms of cause, developmental profile, nature and degree of impairments and their social and personal backgrounds. Overall, people with learning disabilities make up only a small minority of the population, however it is well recognized that they have increased overall health care needs, including mental health needs. It has been estimated there are 210 000 people living in England and Wales who have a severe or profound learning disability: only 25 000 (12%) of these are older people aged over 60 years. Of the 1.2 million people with mild or moderate learning disability, 265 000 (21%) of these are older people over the age of 60. Life expectancy seems to be influenced by severity of learning disability, the age profile of the mild to moderate learning-disabled population being much more closely matched to that of the general population. As a result of this differential mortality, across the spectrum of disability there is a reduced level of learning disability with advancing age, and older people with learning disabilities, when considered as a group, have higher levels of functional ability (and reduced levels of challenging behaviour) than the younger group.