Multimorbidity and Polypharmacy Are Independently Associated With Mortality in Older People With Intellectual Disabilities: A 5-Year Follow-Up From the HA-ID Study.
Four or more illnesses or five-plus meds double early death risk in clients with ID who are 50 and up.
01Research in Context
What this study did
Researchers tracked the adults with intellectual disability for five years. Everyone was 50 or older and lived in the Netherlands.
They counted how many chronic conditions each person had and how many medicines they took every day. Then they watched who died and who lived.
What they found
People with four or more health problems were twice as likely to die during the study. The same risk jump happened for people taking five or more daily drugs.
The extra risk stayed even after the team adjusted for age, sex, and Down syndrome. More illness or more pills meant a shorter life, plain and simple.
How this fits with other research
Landes (2017) first showed that adults with ID die sooner than typical peers, but that gap shrinks as everyone gets older. Eggleston et al. (2018) now names the culprits: multiple illnesses and heavy pill loads.
Pitchford et al. (2019) used the same Dutch group and found these same adults land back in the hospital often, especially for nerve and bone problems. The trio of studies paints one clear picture: older age plus medical complexity equals bad news.
Lin et al. (2011) warned that managers feel unprepared for early aging in ID. The new numbers prove the managers were right to worry.
Why it matters
If your client is 50-plus and carries a long diagnosis list or a bulky med sheet, flag the case for a medical review. Push for annual pill checks, care coordination, and proactive specialist visits. Your behavior plan can include health-tracking goals like daily weight or seizure log, but only if the medical team is looped in. Quick action can cut the doubled death risk these folks now face.
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02At a glance
03Original abstract
We studied the association between multimorbidity, polypharmacy, and mortality in 1,050 older adults (50+) with intellectual disability (ID). Multimorbidity (presence of ≥ 4 chronic health conditions) and polypharmacy (presence ≥ 5 chronic medication prescriptions) were collected at baseline. Multimorbidity included a wide range of disorders, including hearing impairment, thyroid dysfunction, autism, and cancer. Mortality data were collected during a 5-year follow-up period. Cox proportional hazards models were used to determine the independent association between multimorbidity and polypharmacy with survival. Models were adjusted for age, sex, level of ID, and the presence of Down syndrome. We observed that people classified as having multimorbidity or polypharmacy at baseline were 2.60 (95% CI = 1.86-3.66) and 2.32 (95% CI = 1.70-3.16) times more likely to decease during the follow-up period, respectively, independent of age, sex, level of ID, and the presence of Down syndrome. Although slightly attenuated, we found similar hazard ratios if the model for multimorbidity was adjusted for polypharmacy and vice versa. We showed for the first time that multimorbidity and polypharmacy are strong predictors for mortality in people with ID. Awareness and screening of these conditions is important to start existing treatments as soon as possible. Future research is required to develop interventions for older people with ID, aiming to reduce the incidence of polypharmacy and multimorbidity.
American journal on intellectual and developmental disabilities, 2018 · doi:10.1352/1944-7558-123.1.72