A study on prescriptions contributing to the risk of high anticholinergic burden in adults with intellectual disabilities: retrospective record linkage study
Abstract Background People with intellectual disabilities may face a disproportionate risk of experiencing high anticholinergic burden, and its negative sequalae, from a range of medications, and at younger ages than the general population, but there has been little previous study. Our aim was to de...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-10-01
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| Series: | Annals of General Psychiatry |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12991-022-00418-x |
| _version_ | 1811257036859506688 |
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| author | McKernan Laura Ward Sally-Ann Cooper Angela Henderson Bethany Stanley Nicola Greenlaw Christine Pacitti Deborah Cairns |
| author_facet | McKernan Laura Ward Sally-Ann Cooper Angela Henderson Bethany Stanley Nicola Greenlaw Christine Pacitti Deborah Cairns |
| author_sort | McKernan Laura Ward |
| collection | DOAJ |
| description | Abstract Background People with intellectual disabilities may face a disproportionate risk of experiencing high anticholinergic burden, and its negative sequalae, from a range of medications, and at younger ages than the general population, but there has been little previous study. Our aim was to determine the source of anticholinergic burden from prescribed medication. Methods Retrospective matched observational study using record linkage. Adults with (n = 4,305), and without (n = 12,915), intellectual disabilities matched by age-, sex- and neighbourhood deprivation. The main outcome measure was the prescription of long-term (approximately 12 months use) anticholinergic medications overall (classified according to the Anticholinergic Risk Scale [ARS]), by drug class, individual drugs, and polypharmacy. Results Adults with n = 1,654 (38.4%), and without n = 3,047 (23.6%), intellectual disabilities were prescribed medications long-term with anticholinergic effects. Of those on such drugs, adults with intellectual disabilities were most likely to be on central nervous system (62.6%), gastrointestinal (46.7%), and cardiovascular (28.4%) medications. They were prescribed more central nervous system, gynaecological/urinary tract, musculoskeletal, and respiratory medications, and less cardiovascular, infection, and endocrine medications than their matched comparators. Regardless of age, sex, or neighbourhood deprivation, adults with intellectual disabilities had greater odds of being prescribed antipsychotics (OR = 5.37 [4.40–6.57], p < 0.001), antiepileptics (OR = 2.57 [2.22–2.99], p < 0.001), and anxiolytics/hypnotics (OR = 1.28 [1.06–1.56], p = 0.012). Compared to the general population, adults with intellectual disabilities were more likely to be exposed to overall anticholinergic polypharmacy (OR = 1.48 [1.33–1.66], p < 0.001), and to psychotropic polypharmacy (OR = 2.79 [2.41–3.23], p < 0.001). Conclusions Adults with intellectual disabilities are exposed to a greater risk of having very high anticholinergic burden through polypharmacy from several classes of medications, which may be prescribed by several different prescribers. There is a need for evidence-based recommendations specifically about people with intellectual disabilities with multiple physical and mental ill-health conditions to optimise medication use, reduce inappropriate prescribing and adverse anticholinergic effects. |
| first_indexed | 2024-04-12T17:50:12Z |
| format | Article |
| id | doaj.art-a89f7077d7624f53a50912027d5ae430 |
| institution | Directory Open Access Journal |
| issn | 1744-859X |
| language | English |
| last_indexed | 2024-04-12T17:50:12Z |
| publishDate | 2022-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Annals of General Psychiatry |
| spelling | doaj.art-a89f7077d7624f53a50912027d5ae4302022-12-22T03:22:32ZengBMCAnnals of General Psychiatry1744-859X2022-10-0121111010.1186/s12991-022-00418-xA study on prescriptions contributing to the risk of high anticholinergic burden in adults with intellectual disabilities: retrospective record linkage studyMcKernan Laura Ward0Sally-Ann Cooper1Angela Henderson2Bethany Stanley3Nicola Greenlaw4Christine Pacitti5Deborah Cairns6Institute of Health and Wellbeing, University of GlasgowInstitute of Health and Wellbeing, University of GlasgowInstitute of Health and Wellbeing, University of GlasgowRobertson Centre for Biostatistics, University of GlasgowRobertson Centre for Biostatistics, University of GlasgowGreater Glasgow & Clyde NHS, Leverndale HospitalInstitute of Health and Wellbeing, University of GlasgowAbstract Background People with intellectual disabilities may face a disproportionate risk of experiencing high anticholinergic burden, and its negative sequalae, from a range of medications, and at younger ages than the general population, but there has been little previous study. Our aim was to determine the source of anticholinergic burden from prescribed medication. Methods Retrospective matched observational study using record linkage. Adults with (n = 4,305), and without (n = 12,915), intellectual disabilities matched by age-, sex- and neighbourhood deprivation. The main outcome measure was the prescription of long-term (approximately 12 months use) anticholinergic medications overall (classified according to the Anticholinergic Risk Scale [ARS]), by drug class, individual drugs, and polypharmacy. Results Adults with n = 1,654 (38.4%), and without n = 3,047 (23.6%), intellectual disabilities were prescribed medications long-term with anticholinergic effects. Of those on such drugs, adults with intellectual disabilities were most likely to be on central nervous system (62.6%), gastrointestinal (46.7%), and cardiovascular (28.4%) medications. They were prescribed more central nervous system, gynaecological/urinary tract, musculoskeletal, and respiratory medications, and less cardiovascular, infection, and endocrine medications than their matched comparators. Regardless of age, sex, or neighbourhood deprivation, adults with intellectual disabilities had greater odds of being prescribed antipsychotics (OR = 5.37 [4.40–6.57], p < 0.001), antiepileptics (OR = 2.57 [2.22–2.99], p < 0.001), and anxiolytics/hypnotics (OR = 1.28 [1.06–1.56], p = 0.012). Compared to the general population, adults with intellectual disabilities were more likely to be exposed to overall anticholinergic polypharmacy (OR = 1.48 [1.33–1.66], p < 0.001), and to psychotropic polypharmacy (OR = 2.79 [2.41–3.23], p < 0.001). Conclusions Adults with intellectual disabilities are exposed to a greater risk of having very high anticholinergic burden through polypharmacy from several classes of medications, which may be prescribed by several different prescribers. There is a need for evidence-based recommendations specifically about people with intellectual disabilities with multiple physical and mental ill-health conditions to optimise medication use, reduce inappropriate prescribing and adverse anticholinergic effects.https://doi.org/10.1186/s12991-022-00418-xIntellectual disabilitiesAnticholinergic burdenPolypharmacyPsychotropics |
| spellingShingle | McKernan Laura Ward Sally-Ann Cooper Angela Henderson Bethany Stanley Nicola Greenlaw Christine Pacitti Deborah Cairns A study on prescriptions contributing to the risk of high anticholinergic burden in adults with intellectual disabilities: retrospective record linkage study Annals of General Psychiatry Intellectual disabilities Anticholinergic burden Polypharmacy Psychotropics |
| title | A study on prescriptions contributing to the risk of high anticholinergic burden in adults with intellectual disabilities: retrospective record linkage study |
| title_full | A study on prescriptions contributing to the risk of high anticholinergic burden in adults with intellectual disabilities: retrospective record linkage study |
| title_fullStr | A study on prescriptions contributing to the risk of high anticholinergic burden in adults with intellectual disabilities: retrospective record linkage study |
| title_full_unstemmed | A study on prescriptions contributing to the risk of high anticholinergic burden in adults with intellectual disabilities: retrospective record linkage study |
| title_short | A study on prescriptions contributing to the risk of high anticholinergic burden in adults with intellectual disabilities: retrospective record linkage study |
| title_sort | study on prescriptions contributing to the risk of high anticholinergic burden in adults with intellectual disabilities retrospective record linkage study |
| topic | Intellectual disabilities Anticholinergic burden Polypharmacy Psychotropics |
| url | https://doi.org/10.1186/s12991-022-00418-x |
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