Medicine use in people with intellectual disabilities: a Finnish nationwide register study.
In Finland, people with ID get medicine far more often and spend four times more than peers, with antipsychotic use leading the gap.
01Research in Context
What this study did
Boswell et al. (2023) counted every prescription filled in Finland during 2019. They matched each person with intellectual disability to a same-age, same-sex person without ID. Then they compared who got medicine and how much it cost.
The team used government registers, so no one had to fill out surveys. Every pharmacy visit was in the data.
What they found
Eighty-three out of every 100 people with ID picked up at least one drug. For matched controls the number was 70. Antipsychotic use was 12 times higher in the ID group. Median drug spending for people with ID was four times larger.
How this fits with other research
de Kuijper et al. (2010) saw the same pattern earlier. In Dutch residential homes, one in three adults with ID took antipsychotics. Most prescriptions were for behavior, not for psychosis.
Chiang et al. (2013) found triple medical costs in Taiwanese youth with ID. The Finnish adults now show the same cost jump, proving the gap lasts across age groups and countries.
de Kuijper et al. (2013) and Scheifes et al. (2016) warn that high use brings harm. Half of long-term users had tremors or weight gain. Eighty-four percent had other side effects that hurt quality of life. The Finnish study does not report harm, but the risk is still real.
Why it matters
You will see many clients with ID who take antipsychotics or other psychotropics. Ask why each drug started and if behavior plans have been tried first. Track side effects like drowsiness, tremors, or weight gain. Work with prescribers to taper when behavior support replaces medication. The data say the pills are common; our job is to make sure they are still needed.
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02At a glance
03Original abstract
BACKGROUND: People with intellectual disability (ID) are a vulnerable group in our society; many of them depend on other people for assistance in their everyday lives. Compared with the general population, people with ID have poorer general health and, therefore, need more healthcare services and use more medicines. The aim of this study is to define the population of all Finnish people with ID using administrative data and to compare their medicine use and expenditure on medicines to those of the age-matched and sex-matched controls. METHODS: People with ID and their age-matched and sex-matched controls (1:1) were extracted from nationwide healthcare and social allowance registers. Administrative register data on all prescription medicine purchases in 2019 were used to determine the prevalence of medicine use in both groups on a general level and by medicine categories. The differences in the prevalence of medicine use between the two groups were analysed using the logistic regression model. In addition, we studied the total expenditure on reimbursable medicine purchases covered by the National Health Insurance between people with ID and control group. RESULTS: The subpopulation of people with ID consisted 37 196 individuals, of whom 82.7% purchased prescription medicines in 2019. The corresponding share of individuals purchasing prescription medicines in the control group was 70.3%. The differences in the prevalence of medicine use between the two populations were highest in the younger age groups (0-6, 7-12 and 13-17). In the study population, 28.1% (OR = 12.28; 95% CI: 11.54-13.07) of the people used antipsychotics, making it the most used medicine category in people with ID. In the control group, 3.3% of people used antipsychotics. Compared with the control group, the use of antiepileptics, drugs for constipation, mineral supplements and anxiolytics was four to seven times higher among people with ID. Furthermore, the median expenditure on medicine use among people with ID was four times higher than in the control group. CONCLUSIONS: Compared with the control group, people with ID used more medicines, especially psychotropics, and their expenditure on medicine use was higher.
Journal of intellectual disability research : JIDR, 2023 · doi:10.1111/jir.12988