Prescription errors in older individuals with an intellectual disability: prevalence and risk factors in the Healthy Ageing and Intellectual Disability Study.
Nearly half of adults with ID aged 50-plus have medication errors—screen those on multiple or brain-acting drugs first.
01Research in Context
What this study did
Tassé et al. (2013) checked prescription sheets of older adults with intellectual disability. They hunted for dosing mistakes, drug clashes, or unneeded pills.
The team looked at one point in time. They wanted to know how common errors are and what raises the risk.
What they found
Almost half of the adults had at least one prescription error. The biggest red flags were taking many drugs at once and using medicines that act on the brain.
In short, polypharmacy and CNS drugs spelled trouble.
How this fits with other research
Older reviews saw heavy antipsychotic use but could not say if it helped. Webb et al. (1999) and Matson et al. (1999) found zero RCT evidence that these drugs improve behavior or schizophrenia symptoms in adults with ID.
Burack et al. (2004) later counted 873 Australians with ID on antipsychotics, mostly for behavior control. Tassé et al. (2013) now show the same drug class drives prescription errors, linking the old worry of over-use to a new worry of harm.
Prigge et al. (2013) also found paperwork errors in death certificates of adults with ID. Together the studies paint a pattern: administrative systems often fail this aging group.
Why it matters
If you serve adults with ID, treat every psychotropic order as a potential mistake. Run a quick med count in your next team meeting. Flag clients on three or more drugs, especially CNS agents, for pharmacist review. A ten-minute screen can cut errors and side effects.
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02At a glance
03Original abstract
Prescribing pharmacotherapy for older individuals with an intellectual disability (ID) is a complex process, possibly leading to an increased risk of prescription errors. The objectives of this study were (1) to determine the prevalence of older individuals with an intellectual disability with at least one prescription error and (2) to identify potential risk factors for these prescription errors (age, gender, body mass index (BMI), frailty index, level of intellectual disability and living situation). The study population consisted of 600 older (≥ 50 years) individuals with an ID using one or more drugs who were randomly selected from the study cohort of the Healthy Ageing and Intellectual Disability (HA-ID) Study. The medication used at the time of measurement was screened for errors by a hospital pharmacist/clinical pharmacologist and a Master's student pharmacy using consensus methodology. Participants with one or more prescription errors were compared to participants without prescription errors by multivariate logistic regression to identify potential risk factors. The prevalence of individuals with one or more prescription errors was 47.5% (285 of 600 individuals; 95% confidence interval (CI) 43-52%). Relevant errors, defined as errors that actually do require a change of pharmacotherapy, were identified in 26.8% of the individuals (161 of 600 individuals; 95% CI 23-30%). Higher age (adjusted odds ratio (OR adj) 1.03; 95% CI 1.01-1.06), less severe intellectual disability (moderate: OR adj 0.48; 95% CI 0.31-0.74 and severe: OR adj 0.56; 95% CI 0.32-0.98), higher BMI (OR adj 1.04; 95% CI 1.01-1.08), higher frailty index (0.39-0.54: OR adj 2.4; 95% CI 1.21-4.77 and ≥ 0.55: OR adj 3.4; 95% CI 1.03-11.02), polypharmacy (OR adj 8.06; 95% CI 5.59-11.62) and use of medicines acting on the central nervous system (OR adj 3.34; 95% CI 2.35-4.73) were independently associated with the occurrence of prescription errors. Interventions targeted to high risk patients should be designed and implemented to improve pharmacotherapy in older individuals with an intellectual disability.
Research in developmental disabilities, 2013 · doi:10.1016/j.ridd.2013.02.005