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    Rights statement: This is the peer reviewed version of the following article: es in accordance With Wiley Terms and Conditions for self-archiving. McMahon, M., Hatton, C., and Bowring, D. L. (2020) Polypharmacy and psychotropic polypharmacy in adults with intellectual disability: a cross‐sectional total population study. Journal of Intellectual Disability Research, 64: 834– 851. https://doi.org/10.1111/jir.12775 which has been published in final form at https://onlinelibrary.wiley.com/doi/10.1111/jir.12775 This article may be used for non-commercial purposes.

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    Embargo ends: 9/09/22

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Polypharmacy and psychotropic polypharmacy in adults with intellectual disability: a cross‐sectional total population study

Research output: Contribution to journalJournal articlepeer-review

Published
<mark>Journal publication date</mark>1/11/2020
<mark>Journal</mark>Journal of Intellectual Disability Research
Issue number11
Volume64
Number of pages17
Pages (from-to)834-851
Publication StatusPublished
Early online date9/09/20
<mark>Original language</mark>English

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.

Bibliographic note

This is the peer reviewed version of the following article: es in accordance With Wiley Terms and Conditions for self-archiving. McMahon, M., Hatton, C., and Bowring, D. L. (2020) Polypharmacy and psychotropic polypharmacy in adults with intellectual disability: a cross‐sectional total population study. Journal of Intellectual Disability Research, 64: 834– 851. https://doi.org/10.1111/jir.12775 which has been published in final form at https://onlinelibrary.wiley.com/doi/10.1111/jir.12775 This article may be used for non-commercial purposes.