Factors associated with polypharmacy and excessive polypharmacy in older people with Intellectual Disability differ from the general population; a cross-sectional observational nationwide study

Objectives: (1) To evaluate the prevalence of polypharmacy (5–9 medicines) and excessive polypharmacy (10+ medicines) and (2) to determine associated demographic and clinical characteristics in an ageing population with intellectual disabilities (IDs). Design: Observational cross-sectional study. Setting: Wave One (2009/2010) of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA). Participants: A nationally representative sample of 753 persons with ID, aged between 41 and 90 years. Participants/proxy reported medicines ( prescription and over the counter) taken on a regular basis; medication data was available for 736 participants (98%). Main outcome measures/interventions: Participants were divided into those with no polypharmacy (0–4 medicines), polypharmacy (5–9 medicines) and excessive polypharmacy (10+ medicines). Medication use patterns were analysed according to demographic variables and reported chronic conditions. A multinomial logistic regression model identified factors associated with polypharmacy (5–9 medicines) and excessive polypharmacy (≥10 medicines). Results: Overall, 90% of participants reported use of medicines. Polypharmacy was observed in 31.5% of participants and excessive polypharmacy in 20.1%. Living in a residential institution, and reporting a mental health or neurological condition were strongly associated with polypharmacy and excessive polypharmacy after adjusting for confounders, but age or gender had no significant effect. Conclusions: Polypharmacy was commonplace for older adults with ID and may be partly explained by the high prevalence of multimorbidity reported. Review of appropriateness of medication use is essential, as polypharmacy places ageing people with ID at risk of adverse effects

Factors associated with polypharmacy and excessive polypharmacy in older people with Intellectual Disability differ from the general population; a cross-sectional observational nationwide study

Objectives: (1) To evaluate the prevalence of polypharmacy (5–9 medicines) and excessive polypharmacy (10+ medicines) and (2) to determine associated demographic and clinical characteristics in an ageing population with intellectual disabilities (IDs). Design: Observational cross-sectional study. Setting: Wave One (2009/2010) of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA). Participants: A nationally representative sample of 753 persons with ID, aged between 41 and 90 years. Participants/proxy reported medicines ( prescription and over the counter) taken on a regular basis; medication data was available for 736 participants (98%). Main outcome measures/interventions: Participants were divided into those with no polypharmacy (0–4 medicines), polypharmacy (5–9 medicines) and excessive polypharmacy (10+ medicines). Medication use patterns were analysed according to demographic variables and reported chronic conditions. A multinomial logistic regression model identified factors associated with polypharmacy (5–9 medicines) and excessive polypharmacy (≥10 medicines). Results: Overall, 90% of participants reported use of medicines. Polypharmacy was observed in 31.5% of participants and excessive polypharmacy in 20.1%. Living in a residential institution, and reporting a mental health or neurological condition were strongly associated with polypharmacy and excessive polypharmacy after adjusting for confounders, but age or gender had no significant effect. Conclusions: Polypharmacy was commonplace for older adults with ID and may be partly explained by the high prevalence of multimorbidity reported. Review of appropriateness of medication use is essential, as polypharmacy places ageing people with ID at risk of adverse effects

Sedative load and frailty among community-dwelling population aged ≥65 years

OBJECTIVE: To explore the association between use of sedative drugs and frailty. DESIGN: Cross-sectional study. SETTING: First wave of The Irish Longitudinal Study on Ageing (TILDA), a nationally representative cohort of the community-dwelling population aged 50 years or older in Ireland. PARTICIPANTS: Participants were 1642 men and 1804 women aged 65 years or older. MEASUREMENTS: Regular use of sedative drugs determined according to the sedative load (SL) model, frailty phenotype status, and frailty deficit index (FI) score assessed using validated, established protocols. RESULTS: Overall, 19% of the participants took sedative drugs, most frequently hypnotics and antidepressants. Sedative drug use was at 46% for frail, 23% for prefrail, and 9% for nonfrail participants. After adjustment for covariates, SL was positively associated with being prefrail (odds ratio [OR] 1.27; 95% confidence interval [CI] 1.11-1.46) and frail (OR 1.30; 95% CI 1.02-1.64). Advancing age but not sex remained significant (P < .001). After adjustment for covariates, the association between SL and the FI was also significant at P ≤ .001 (β = 1.77; 95% CI 1.13-2.42). CONCLUSION: Higher SL was positively associated with phenotype frailty and the FI. This suggests that careful consideration must be given when prescribing sedatives to frail older adults, who are most vulnerable to adverse drug reactions and adverse health outcomes

Association of anticholinergic burden with adverse effects in older people with intellectual disabilities:an observational cross-sectional study

BACKGROUND: No studies to date have investigated cumulative anticholinergic exposure and its effects in adults with intellectual disabilities. AIMS: To determine the cumulative exposure to anticholinergics and the factors associated with high exposure. METHOD: A modified Anticholinergic Cognitive Burden (ACB) scale score was calculated for a representative cohort of 736 people over 40 years old with intellectual disabilities, and associations with demographic and clinical factors assessed. RESULTS: Age over 65 years was associated with higher exposure (ACB 1-4 odds ratio (OR) = 3.28, 95% CI 1.49-7.28, ACB 5+ OR = 3.08, 95% CI 1.20-7.63), as was a mental health condition (ACB 1-4 OR = 9.79, 95% CI 5.63-17.02, ACB 5+ OR = 23.74, 95% CI 12.29-45.83). Daytime drowsiness was associated with higher ACB (P<0.001) and chronic constipation reported more frequently (26.6% ACB 5+ v. 7.5% ACB 0, P<0.001). CONCLUSIONS: Older people with intellectual disabilities and with mental health conditions were exposed to high anticholinergic burden. This was associated with daytime dozing and constipation

Zdravje starostnikov in oseb s posebnimi potrebami ter njihova uporaba zdravil in prehranskih dopolnil

Due to the accelerated ageing of the worldwide population the proportion of elderly (aged 65 and over) people is growing. This will have implications for the planning and delivery of health and social care. Understanding how (older) people manage their pharmacotherapy can help to maximise the benefits of medicines and prevent potential tangible side effects as older people are more vulnerable to adverse drug events due to diminished physiological reserve associated with ageing. This can be exacerbated further by acute or chronic disease and by the effects of the medicines used to treat them. Older people are often prescribed sedative medicines which have been associated with falls, fractures, physical and cognitive impairment, and disability. Frailty as one of more complex geriatric syndrome, develops as a consequence of age-related declines in many physiological systems, resulting in vulnerability to stressors (e.g. infection or hospitalisation) and adverse health outcomes as falls and fractures, mobility and functional declines, hospitalisation, nursing home admissions and death. To test the hypothesis that there is an association between the use of sedative medicines and frailty we used cross-sectional data from the first wave of the Irish Longitudinal Study on Ageing (TILDA). The elderly subgroup in TILDA study cohort included 3,446 participants representative of the community-living population in Ireland. Frailty status was measured using two different methods: phenotype (Fried’s) frailty and frailty index (FI). Cumulative effect of multiple sedative medicines was calculated using the sedative load model which was updated to reflect current knowledge about the sedative effects of medicines. Sedative medicines (most frequently hypnotics and antidepressants) were used by one fifth (19.4%) of participants and was higher in women than in men. Frail participants (4.2%) were significantly older, had more chronic diseases, poorer education and more (ADL and IADL) disabilities but also higher polypharmacotherapy (5 or more medicines) and sedative medicine use. Sedative load was independently associated with both phenotype frailty and FI frailty. The use of medicines with sedative properties in older Irish adults was significant and more prevalent in the subpopulation with the poorest health status. These findings could have important clinical implications with respect to prevention of adverse health outcomes in the elderly. In the ageing population the awareness and willingness of preserving health and intensifying pharmacological treatment with food supplements (FS) is strong. The main purpose of food supplements use is to provide nutrients potentially missing in the food consumed due to the nature of the food intake (e.g. poor quality), specific diet or because of increased need for a specific nutrient due to disease or metabolic malfunction (osteoporosis, anaemia,…), pregnancy or lifestyle activities (increased physical activity). In combination with medicines they may be used to augment treatment needs or to meet separate needs but both may incur risk as well as benefit. We researched the use of food supplements in the Irish community-dwelling population aged 50 years and over alone and in concurrent combination with medicines within the TILDA project, to help us understand better what are the specific factors associated with its pattern. Overall every seventh respondent (14.0%) reported concurrent medicine-FS use. The range of combined use varied from 1 supplement with 19 medicines to 10 supplements with 2 medicines. The most prevalent supplements were calcium with or without D vitamin, omega-3-fatty acids and glucosamine. Combined use was highest in those taking medicines for bone diseases (60.0%mostly calcium with or without D vitamin) and lowest in those taking medicines for diabetes (15.7%). At least one potential medicine-supplement interaction of any kind was detected in 4.1% respondents. Anticoagulants and NSAIDs were among the most frequently interacting medicines. Overall, potential major interactions were detected in 4.5% of those reported any medicine-FS use. Independent factors for FS use in the TILDA cohort (aged 50 years and over) were being female, employed, non-smoker, having higher education and living alone. Furthermore, factors were having private insurance, three or more chronic conditions and polypharmacotherapy. Similarly were independent factors for overall combined medicine-FS use being female, employed, having private insurance and number of chronic conditions. The variability in FS use in the population showed evidence of unmet need and therefore unrealised benefits among some sub-groups and of exposure to avoidable and potentially serious drug interactions among others. Both of these outcomes may increase in the future as the proportion of the over 50s with multimorbidity, polypharmacotherapy and supplements use grows. Intellectual disability (ID) is a disability characterised by significant limitations in both intellectual functioning and in adaptive behaviours, which covers many everyday social and practical skills. Life expectancy is increasing in this population similarly to the non-ID population. Increasing numbers of people with ID are living in the community and are dependent upon primary health care services (e.g. GP, community pharmacy). All this, however, brings new challenges which need to be addressed at the primary health care level to accommodate the special demands that this population may pose, including the differences in the medicine and food supplement utilisation pattern. Data used in our research was taken from the first wave of the ID supplement to TILDA. To make comparison between the ID population from the Intellectual disability supplement to TILDA and TILDA cohort possible, only the community dwelling subpopulation of person aged 50 years and over with ID were included in the study. It was discovered that ID population was exposed to higher multimorbidity and also pharmacotherapy compared to the non-ID population while food supplement use was almost double. Furthermore, more people with ID reported concomitant medicine and food supplement use and compared to the non-ID population it was more than double. The intensity of medicine use was evaluated using the number of medicines per 100 enrolled participants and was twice as great in the ID cohort (503 versus 251) as in the non-ID cohort. The diversity of medicines used was substantial with the number of different preparations (ATC level 5) per 100 participants being 95.8 (ID) vs. 7.0 (non-ID). In contrast to the greater variety of medicines per participant identified in the IDS TILDA cohort, supplement utilisation illustrated minimal diversity with only 10 types of supplements in use (compared to 134 in the non-ID cohort). The most reported therapeutic class in the non-ID cohort were “Lipid modifying agents” (ATC C10) while in the ID cohort were “Psycholeptics” (ATC N05) with antipsychotics being most prevalent. Long term use of sedative and anticholinergic medicines have been associated with cognitive impairment, increased risk of falls and hospitalisation. This evidence strongly suggests that in particular the ID population studied in this work is exposed to risks and vulnerable to harm from the high levels of medicines and supplements used. Since this population live in the community and it is most appropriate that they continue to be cared for in the community, those Primary Care providers who share responsibility for the provision of medicines and supplements, general practitioners and community pharmacists, should be supported and empowered to collaborate in the care of these diverse populations in need.Delež starostnikov (oseb starejših od 65 let) v svetu narašča zaradi podaljševanja življenjske dobe. To pomembno vpliva na načrtovanje in organizacijo zdravstvenega in socialnega varstva. Dobro razumevanje tega, kako starostniki jemljejo zdravila, lahko izboljša pozitivne učinke zdravljenja oziroma prepreči morebitne znatne neželene učinke zdravil. Starostniki so namreč populacija s povečanim tveganjem za neželene učinke zdravil do katerega pride zaradi zmanjšane fiziološke kapacitete organizma, ki nastanejo ravno zaradi staranja. Dodatno lahko poslabšajo stanje kronične ali akutne bolezni, kot tudi zdravila, ki jih starostnik jemlje ob tem. Starostnikom so pogosto predpisana zdravila s sedativnim učinkom, pri katerih je bila ugotovljena povezanost s padci, zlomi, telesnimi in kognitivnimi okvarami ter invalidnostjo. Starostna krhkost kot eden bolj kompleksnih geriatričnih sindromov, se razvije zaradi učinkov staranja na več fizioloških sistemov, kar vodi v povečano občutljivost na stresne dejavnike (denimo okužbe ali hospitalizacija) in je povezana s padci, zlomi, zmanjšanjem mobilnosti in funkcionalnosti, hospitalizacijo, sprejemom v domove za ostarele in smrtjo. V namen preverjanja hipoteze, ali obstaja povezava med uporabo zdravil s sedativnim učinkom ter starostno krhkostjo, smo uporabili presečne podatke iz prvega leta Irske longitudinalne študije o staranju (TILDA). Subpopulacija starostnikov je vključevala 3446 oseb živečih na domu v Republiki Irski. Stopnja starostne oslabelosti je bila določena z uporabo dveh metod: fenotipska (Friedova) krhkost ter krhkostni indeks (FI). Kumulativni učinek jemanja večih zdravil s sedativnim učinkom je bil kvantificiran s pomočjo modela sedativnega bremena, ki smo ga posodobili, tako da je vključeval zadnja spoznanja o zdravilih s sedativnim učinkom. Zdravila s sedativnim učinkom (najbolj pogosto uspavala in antidepresivi) so bila poročana pri petini (19,4%) vključenih v raziskavo, vendar več pri ženskah kot pri moških. Posamezniki s starostno krhkostjo (4,2%) so bili pomembno starejši, so imeli več kroničnih bolezni, slabšo izobrazbo in več tipov invalidnosti (vsakodnevne aktivnosti/inštrumentirane vsakodnevne aktivnosti). Poleg tega so imeli več polifarmakoterapije (sočasno jemanje petih in več zdravil) ter zdravil s sedativnim učinkom. Sedativno breme je bilo neodvisno povezano tako s fenotipsko krhkostjo, kot tudi z krhkostnim indeksom. Uporaba zdravil s sedativnim učinkom je med starostniki na Irskem evidentna, kar še posebej velja za osebe s slabšim zdravstvenim stanjem. Ti izsledki bi lahko pomembno vplivali na pripravo ukrepov z namenom preprečevanja zapletov pri zdravljenju. Ozaveščenost glede ohranjanja zdravja in jemanja prehranskih dopolnil kot dopolnilo zdravljenju z zdravili je pri starajoči populaciji zelo prisotno. Glavni namen jemanja prehranskih dopolnil je zagotoviti potrebna hranila, ki morda manjkajo v vsakodnevni prehrani. Do te potrebe pride zaradi uživanja s hranili siromašne prehrane, posebne diete, ali povečane potrebe po specifičnih hranilih zaradi bolezni, metabolne motnje (npr. osteoporoza, anemija), nosečnosti ali življenjskega sloga (povečana fizična aktivnost). V kombinaciji z zdravili se prehranska dopolnila jemljejo za obogatitev tega zdravljenja ali pa za zadovoljevanje drugih potreb, vendar lahko takšna sočasna raba pomeni tako tveganje za neželene učinke kot doprinos k boljšemu zdravju. V naši raziskavi znotraj TILDA smo ugotavljali uporabo prehranskih dopolnil v populaciji oseb starih 50 let in več živečih na domu v Republiki Irski, tako samostojno kot tudi v kombinaciji z jemanjem zdravil, da bi tako bolje razumeli kateri so napovedni dejavniki, ki so povezani z ugotovljenimi vzorci. Skupno je vsak sedmi posameznik vključen v raziskavo (14,0%) poročal sočasno uporabo zdravil in prehranskih dopolnil. Kombinacije so variirale od enega prehranskega dopolnila skupaj z 19 zdravili, do 10 dopolnil skupaj z dvema zdraviloma. Najbolj poročana prehranska dopolnila so bila kalcij z ali brez vitamina D, omega-3-maščobne kisline ter glukozamin. Sočasno jemanje je bilo najbolj pogosto pri tistih, ki so jemali zdravila za kostne bolezni (60,0%največ kalcij z ali brez D vitamina), najmanj pa pri tistih, ki so jemali zdravila za zdravljenje sladkorne bolezni (15,7%). Najmanj eno potencialno součinkovanje med zdravili in prehranskimi dopolnili je bilo ugotovljeno pri 4,1% posameznikov, vključenih v raziskavo. Antikoagulanti in nesteroidni antirevmatiki so bili med najbolj pogostimi zdravili, ki so součinkovala. Potencialno pomembne interakcije so bile ugotovljene pri 4,5% tistih, ki so poročali sočasno uporabo zdravil in prehranskih dopolnil. Neodvisni dejavniki pri osebah starejših od 50 let znotraj raziskave TILDA, ki vplivajo na jemanje prehranskih dopolnil, so bili ženski spol, zaposlenost, nekajenje, višja izobrazba, samsko življenje, prostovoljno zdravstveno zavarovanje, tri ali več kroničnih bolezni ter sočasno jemanje petih ali več zdravil (polifarmakoterapija). Podobno so bili neodvisni dejavniki za sočasno jemanje zdravil skupaj prehranskimi dopolnili ženski spol, zaposlenost, prostovoljno zdravstveno zavarovanje in število kroničnih bolezni. Ugotovljena praksa uporabe prehranskih dopolnil kaže na neizkoriščene možnosti, ki jih za izboljšanje zdravstvenega stanja le-ta ponujajo na eni strani, ter nevarnost za nastanek potencialnih interakcij na drugi strani. Prisotnost obeh (neugodnih) možnosti se bo v prihodnje verjetno le povečala, saj delež oseb starih 50 let in več z večimi kroničnimi boleznimi in polifarmacijo ter uporabo prehranskih dopolnil, narašča. Motnje v duševnem razvoju so opredeljene s pomembno okrnjenimi intelektualnimi zmožnostmi in prilagodljivega vedenja, ki jih uporabljamo v vsakdanjem življenju. Pričakovana življenjska doba oseb z motnjami v duševnem razvoju se podaljšuje in postaja podobna tisti, ki jo dosega populacija brez motenj. Vse več ljudi s temi motnjami živi na domu in se poslužuje storitev izvajalcev primarnega zdravstvenega varstva kot so družinski zdravniki in lekarniški farmacevti. To prinaša nove izzive nosilcem primarnega zdravstvenega varstva, da kar najbolje zadovoljijo posebne potrebe te populacije, vključno z drugačno prakso jemanja zdravil in prehranskih dopolnil. Podatki, ki smo jih uporabili pri raziskovanju, izhajajo iz prvega leta »ID suplementa« k TILDA študiji. Da smo lahko primerjali populacijo iz obeh študij, smo v populaciji z motnjami v duševnem razvoju upoštevali le tiste posameznike, ki so živeli na domu (torej niso bili institucionalizirani) in so bili stari 50 let in več. Ugotovili smo, da so imeli posamezniki z motnjami v duševnem razvoju več kroničnih bolezni ter so poročali jemanje večih zdravil kot posamezniki brez motenj, ob tem pa je bila poraba prehranskih dopolnil skoraj dvojna. Več kot podvojeno je bilo tudi sočasno jemanje zdravil in prehranskih dopolnil. Nivo intenzivnosti zdravljenja z zdravili je bila ocenjena s številom zdravil na 100 posameznikov vključenih v posamezno kohorto in je bila v primeru populacije z motnjami v duševnem razvoju dvojna (503 proti 251). Raznovrstnost poročanih zdravil (ATC 5) v tej populaciji je bila bistveno višja v primerjavi s populacijo brez motenj in je znašala kar 95,8 proti 7,0. V nasprotju s tem, pa je bila raznovrstnost poročanih prehranskih dopolnil zelo omejena, saj smo jih identificirali le 10 različnih vrst, medtem ko jih je bilo v populaciji brez duševnih motenj 134. Najbolj poročana skupina zdravil je bila v populaciji brez duševnih motenj »zdravila za spreminjanje ravni serumskih lipidov« v drugi pa »psiholeptiki«, kjer so prevladovali antipsihotiki. Dolgotrajno jemanje zdravil s sedativnim in/ali antiholinergičnim učinkom je povezano z zmanjšanjem kognitivnih funkcij, povečanim tveganjem za padce in hospitalizacijo. Tako je še posebej populacija z motnjami v duševnem razvoju izpostavljena povečanemu tveganju za neželene učinke zdravil in prehranskih dopolnil. Ob tem, da ta populacija živi v običajni skupnosti in že uporablja storitve v primarnem zdravstvu, bi bilo najbolje, da izvajalci primarnega zdravstva, torej družinski zdravniki in lekarniški farmacevti, dobijo možnost dodatnega izobraževanja, da bi skupaj kar najbolje skrbeli za posebne potrebe te populacije

Medication and supplement use in older people with and without intellectual disability: An observational, cross-sectional study.

Understanding the medication and supplement use of aging people is critical to ensuring that health service providers in primary care can optimise use of these agents. An increasing number of people with different levels of intellectual disability (ID) are living in the community and becoming for the first time substantial users of primary health care services. This, however, brings new challenges that need to be addressed at the primary health care level. We quantified the use of medicines and food supplements and described the associated patterns of morbidity in the two comparable cohorts of aging population with and without intellectual disability.This research aligned participants of 50 years and over who lived in the community from two nationally representative cohorts of older people; those with ID from the Intellectual Disability Supplement (n = 238) and those without ID (n = 8,081) from the Irish Longitudinal Study on Ageing.Data showed that both medication and supplement use in the two groups was prevalent but that those with ID received more of both medications and supplements (e.g. polypharmacy was 39.0% in ID vs. 18.1% in non-ID cohort). Moreover, based on an analysis of the therapeutic groups and medications used that treatment was more intense in the ID cohort (95.8 vs. 7.0 International Non-proprietary Names per 100 participants). Supplement use was almost twice as prevalent in the ID group but substantially less diverse with only 10 types of supplements reported. Morbidity was higher in the ID group and showed a higher prevalence of neurological and mental health disorders.The results highlight that the burden of therapy management and the potential risks in those ageing with ID differs substantially from those ageing without ID. Understanding the medication and supplement use of people aging with intellectual disability (ID) is critical to ensuring that health service providers in primary/ambulatory care can optimise use of these agents

Attitudes towards antimicrobial drugs among general population in Croatia, Fyrom, Greece, Hungary, Serbia and Slovenia

Purpose: A pilot study to assess patients' attitudes towards antimicrobials (ABs) in six European countries (Croatia, Former Yugoslav Republic of Macedonia (FYROM), Greece, Hungary, Slovenia and Serbia), as a step preceding educational intervention on the importance of patients' compliance with instructions on taking ABs and consequences of their inappropriate use. Methods: Patients' knowledge, emotions and behaviour regarding ABs were assessed using a structured questionnaire, constructed by a psychologist and intended for general population in six European countries. Questionnaires were filled out by individuals who visited pharmacies and general practitioners. Results: A total of 838 questionnaires were filled in. Respondents from Slovenia showed the best knowledge about ABs, followed by Croatians. The highest willingness for self-medication reported respondents from FYROM. The most positive emotions about ABs were expressed by respondents in Greece and Hungary, and the most negative in Slovenia. All components of attitudes towards antibiotics were influenced by country and level of education. Conclusions: Behaviour regarding ABs complied with emotions and knowledge in all countries. The results of this study may lay a basis for conducting national public campaigns, as a step forward in education of patients on rational AB use