Polypharmacy and psychotropic polypharmacy in adults with intellectual disability: a cross-sectional total population study.
Four in ten adults with ID juggle five-plus medicines—screen for interactions every visit.
01Research in Context
What this study did
Heald et al. (2020) looked at every adult with intellectual disability in one Irish health region. They counted how many people were on five or more medicines at the same time.
The team also noted who was on two or more psychotropic drugs, like antipsychotics or mood pills. They asked about age, where the person lived, and past mental-health history.
What they found
Out of 217 adults, 38 % were on five-plus medicines and 23 % were on two or more psychotropics together. Older adults, people in group homes, and those with a psychiatric past were more likely to be in these groups.
The numbers show polypharmacy is common, not rare, in adults with ID.
How this fits with other research
Haider et al. (2014) saw the same trend earlier in Australia, but their rate was only 21 %. The jump from 21 % to 38 % looks like a contradiction. The gap is real: the 2014 study used a state register, while M et al. captured every adult in a whole health system. Broader catch, higher count.
Higgins et al. (2021) used the exact same 217 Irish adults to show that each extra drug raises the risk of dangerous drug-drug interactions. The 2020 paper tells us "how many"; the 2021 paper tells us "how risky."
Klein et al. (2024) repeated the idea in Canadian youth with IDD and found even higher psychotropic polypharmacy—about 30 %. The problem starts early and continues into adulthood.
Why it matters
If you serve adults with ID, expect two things: many will bring long med lists, and some combos may cause drowsiness or behavior changes. Build a quick med check into every assessment. Flag clients on five or more drugs and ask the doctor to review psychotropics first. Your data sheet can be the trigger that cuts pill load and side effects.
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02At a glance
03Original abstract
BACKGROUND: Adults with intellectual disability (ID) are prescribed high levels of medication, with polypharmacy and psychotropic polypharmacy common. However, reported rates vary between studies, and there has been an over-reliance on obtaining data from convenience samples. The objective of this study was to determine the prevalence of medication use and polypharmacy in a population-level sample of adults with IDs. Factors associated with polypharmacy and psychotropic polypharmacy are explored. METHODS: We used a total population sample of 217 adults with IDs known to services in Jersey (sampling frame n = 285). The Anatomical Therapeutic Chemical classification system was used to categorise medications that participants were currently taking on a regular basis. We examined associations of polypharmacy and psychotropic polypharmacy with socio-economic status, health and demographic variables using univariate and multivariate analyses. RESULTS: A total of 83.4% of participants were prescribed medication, with high doses common. Of the participants, 38.2% were exposed to polypharmacy while 23% of participants were exposed to psychotropic polypharmacy. After controlling for demographic, health and socio-economic characteristics, polypharmacy was significantly associated with older age, increased severity of ID, living in a residential setting and having increased comorbidities. Psychotropic polypharmacy was associated with being male, being aged 50+ years and having had a psychiatric diagnosis over the life course. Being prescribed psychotropic drugs above the defined daily dose was not associated with having had a psychiatric diagnosis over the life course, suggesting the possibility of 'off label' prescribing. CONCLUSIONS: Our results indicate that medication use, in high doses, alongside polypharmacy and psychotropic polypharmacy are highly prevalent in adults with ID. The exposure to multiple medications increases the risk of developing adverse drug events, drug-drug interactions and medication-related problems. Future population-level, prospective cohort studies should examine the prevalence of polypharmacy and psychotropic polypharmacy using standardised definitions and consider the potential impact of adverse drug events, drug-drug interactions and medication-related problems in this population.
Journal of intellectual disability research : JIDR, 2020 · doi:10.1111/jir.12775