Abstract
Background: Polypharmacy and inappropriate prescription are frequent in vulnerable and multi-morbid populations. Adults with intellectual disability (ID) are at risk of being polymedicated because they often present with multiple comorbidities and challenging behaviors.Aim: The objective of this study was thus to evaluate the prevalence of potentially inappropriate medications (PIM) and polypharmacy in a hospital unit dedicated to adults with ID.Methods: A 10-month prospective observational study took place at a hospital unit specializing in the care of adults with ID in Geneva, Switzerland. Once a week, health and prescription data were collected and screened for PIM according to preset definitions.Results: Fourteen patients consented to participate, leading to 20 hospitalization events assessed during the study. Hospitalizations lasted 12.8 weeks on average. ID severities ranged from mild to profound, all degrees of severity being equally represented. One hundred percent of the patients were polymedicated (defined as five drugs or more prescribed simultaneously). A mean number of 9.4 drugs were prescribed per week, including 5.3 psychotropic drugs. The number of prescribed drugs remained stable throughout the hospitalizations. Antipsychotics were the most prescribed drug class (19% of all prescribed drugs), followed by benzodiazepines (13%) and laxatives (12%). A total of 114 PIM were recorded with an average of 5.7 PIM per hospitalization.Conclusions: This study showed that polypharmacy and inappropriate prescription are very common in adults with ID, even though the literature and expert positions advocate for deprescription in these patients. Specific prescribing and deprescribing guidelines are needed for that specific population.
Highlights
Among the numerous definitions of polypharmacy, the most used is the concurrent use of five or more medications [1]
Polypharmacy can be appropriate when drugs are prescribed for patients with multiple comorbidities in a way to improve quality of life or prognosis or even minimize drug side effects [2]
Polypharmacy often is the consequence of inappropriate prescribing and prescription errors and leads to an increased risk of adverse events [2,3,4]
Summary
Among the numerous definitions of polypharmacy, the most used is the concurrent use of five or more medications [1]. Polypharmacy often is the consequence of inappropriate prescribing and prescription errors and leads to an increased risk of adverse events [2,3,4]. In a population-based study, the risk of an adverse drug event increased by 88% for patients taking five drugs or more compared to those who were taking one or two drugs [5]. Studies in vulnerable and polymedicated populations, such as the elderly, showed that inappropriate prescriptions are frequent. The prevalence of inappropriate prescriptions varied between 24 and 73% in a study conducted on geriatric outpatients under polypharmacy [6] Such prevalent numbers vary greatly because medication appropriateness is determined by different criteria. Examples of explicit criteria are the occurrence of expected side effects of prescribed drugs such as falls or confusion in the elderly. Adults with intellectual disability (ID) are at risk of being polymedicated because they often present with multiple comorbidities and challenging behaviors
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