A Study On Prescriptions Contributing To The Risk Of High Anticholinergic Burden In Adults With Intellectual Disabilities: Retrospective Record Linkage Study

Abstract

Background: People with intellectual disabilities face a disproportionate risk of experiencing high anticholinergic burden, and its negative sequalae, at younger ages than the general population. Our aim was to determine the source of that burden from prescribed medication. Methods: Retrospective matched observational study using record linkage. Adults with (n=4,305), and without (n=12,915), intellectual disabilities matched by age-, sex- and neighbourhood deprivation. The main outcome measure was the prescription of long-term (approximately 9 months use) anticholinergic medications overall, by drug class, individual drugs, and polypharmacy.Results: 38.4% and 23.6% of adults with, and without, intellectual disabilities were prescribed medications long-term with anticholinergic properties. Of those on such drugs, adults with intellectual disabilities were most likely to be on central nervous system (62.6%), gastrointestinal (46.7%), and cardiovascular (28.4%) medications. They were prescribed more central nervous system, gynaecological/urinary tract, musculoskeletal, and respiratory medications, and less cardiovascular, infection, and endocrine medications than their matched comparators. Regardless of age, sex, or neighbourhood deprivation, adults with intellectual disabilities had greater odds of being prescribed antipsychotics (OR=5.37 [4.40-6.57], p<0.001), antiepileptics (OR=2.57 [2.22-2.99], p<0.001), and anxiolytics/hypnotics (OR=1.28 [1.06-1.56], p=0.012). Adults with intellectual disabilities were more likely to be exposed to overall anticholinergic polypharmacy (61.3% (n=1,013), 54.7% (n=1,668) respectively, OR=1.48 [1.33-1.66], p<0.001), and to psychotropic polypharmacy than adults without intellectual disabilities (33.7% (n=558), 14.3% (n=435) respectively, OR=2.79 [2.41-3.23], p<0.001).Conclusions: Adults with intellectual disabilities are exposed to a greater risk of having very high anticholinergic burden through polypharmacy from several classes of medications, which may be prescribed by several different prescribers. Clinicians need to be cognisant of this issue, and the potential adverse consequences. These findings highlight the need for regular medication reviews to reduce inappropriate prescribing and adverse anticholinergic effects.