Medication burden and frailty in older adults with intellectual disability: An observational cross‐sectional study

Abstract

Purpose: Recently, efforts have been made to quantify frailty among older adults with intellectual disability (ID). Medication exposure is associated with frailty among older adults without ID. However, there is little research on this association among older adults with ID. The aim of this study was to examine specifically in people with ID the association between frailty and medication exposure, including anticholinergic and sedative medication exposure. Methods: Data were drawn from Wave 2 (2013/2014) of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), a nationally representative study of older adults with ID in Ireland. A modified version of Fried's frailty phenotype was constructed. Drug burden measures were polypharmacy, Drug Burden Index (DBI), Anticholinergic Cognitive Burden (ACB) and Sedative Load Model. Multinomial logistic regression was used to calculate odds ratios (ORs) and identify associations between frailty and drug burden.Results: This study included 570 participants with ID. Excessive polypharmacy (use of ≥10 medications) was significantly associated with being pre-frail (P = .017; OR = 2.56; 95% confidence interval [CI] 1.19-5.50) and frail (P < .001; OR 7.13; 95% CI 2.81-18.12), but DBI, ACB or Sedative Load score were not significantly associated with frailty status (P > .05).Conclusions: This is the first study to examine frailty and its association with medication use including anticholinergic and sedative medication burden among older adults with ID. Further research is required to investigate frailty as measured by other frailty models in relation to medication burden in older adults with ID. K E Y W O R D S frailty, intellectual disability, medication, pharmacoepidemiology 1 | INTRODUCTION Intellectual disability (ID) is a lifelong condition characterised by deficits in cognitive functioning and skills acquisition. 1 Many people with ID, particularly those over 40 years of age, experience multiple disability and premature multi-morbidity 2 and subsequently experience high levels of medication exposure. 3 Average life expectancy among people with ID has increased substantially over the last few decades. 4-6 Nonetheless, there is still inequity in health and early death due to avoidable healthcare issues among people with ID. 7 The concept of an ageing population which now includes people with ID further prompts study of frailty in this group.

Associations of poor sleep quality, chronic pain and depressive symptoms with frailty in older patients: is there a sex difference?

“…From the clinical treatment perspective, older patients with depressive symptoms often have concurrent with sleep disorders and increased medication burdens including sedative-hypnotic drugs and antidepressants [ 45 ]. Apart from polypharmacy, several studies have shown that taking sedative-hypnotic drugs is significantly associated with poor physical function, poor appetite and frailty [ 46 – 48 ]. Antidepressants, as one of the important pharmacological treatment options for clinically diagnosed depressive and anxiety disorders, are associated with frailty, which may increase the risk of adverse effects [ 49 ], falls [ 50 ], and fractures [ 51 ].…”

“…From the clinical treatment perspective, older patients with depressive symptoms often have concurrent with sleep disorders and increased medication burdens including sedativehypnotic drugs and antidepressants [45]. Apart from polypharmacy, several studies have shown that taking sedative-hypnotic drugs is significantly associated with poor physical function, poor appetite and frailty [46][47][48].…”

Impact of drug burden index on delirium in community-dwelling older adults with dementia: A longitudinal observational study

“…Medications with both anticholinergic and sedative effects were included in one group to avoid duplication. In the current study, we classi ed participants as having no exposure (DBI = 0), low exposure (0 < DBI < 1), or high exposure (DBI ≥ 1) [31].…”

Association of anticholinergic burden with undernutrition in older adults: A cross‐sectional study

“…Among several scales or indexes using a similar approach, the ACB scale has recently been reported to show prognostic utility in terms of mortality 31 . In the older adult population, a growing body of evidence has shown that ACB has a more substantial impact on adverse outcomes and the exacerbation of comorbidities than in younger adults 32–34 . We hypothesized that ACB would associate with inadequate nutrition in older age.…”

“…31 In the older adult population, a growing body of evidence has shown that ACB has a more substantial impact on adverse outcomes and the exacerbation of comorbidities than in younger adults. [32][33][34] We hypothesized that ACB would associate with inadequate nutrition in older age. Therefore, our aim in this study was to examine the potential association between ACB and nutrition status in community-dwelling older adults.…”