Risk of anticholinergic burden in adults with intellectual disabilities: a Scottish retrospective cohort study of n = 17 220

Abstract

Background Several drugs have anticholinergic side effects that are associated with adverse health outcomes. Anticholinergic burden studies in adults with intellectual disabilities (ID) have focused exclusively on older adults. This study investigates anticholinergic burden and its associations in adults with ID of all ages (17–94 years). Methods Adults with ID (n = 4 305), each with three general population age–sex–neighbourhood‐matched controls (n = 12 915), were linked to their prescribed medications with anticholinergic effects between 2009 and 2017. Analyses were undertaken using logistic regression models. Results Adults with ID were more likely to be prescribed any anticholinergic medicines, odds ratio (OR) = 1.49 (1.38–1.59), especially ‘very strong’ risk medicines, OR = 2.59 (2.39–2.81); 48.5% had very high total anticholinergic burden (3+) compared with 35.4% of the general population, OR = 1.77 (1.64–1.90). This group difference was greater for males, OR = 2.02 (1.84–2.22), than females, OR = 1.48 (1.33–1.65). Adults with ID had significantly higher odds of having very high total anticholinergic burden up to 75 years old, with the greatest group effect occurring in younger ages, 17‐24‐year‐olds, OR = 3.05 (2.39–3.89), and the extent of the difference decreased as age increased. The main effect of neighbourhood deprivation showed greater group differences with increasing affluence of neighbourhood. Results examining only the ID group showed that very high total anticholinergic burden was greatest for females, OR = 1.21 (1.07–1.37), and those over age 55, and extent of neighbourhood deprivation was not significant. Conclusions Adults with ID are at higher risk of anticholinergic burden than the general population, especially young adults. Overall anticholinergic burden increased with age, but burden was high across all ages in the ID group. Very high total anticholinergic burden is prevalent across all types of neighbourhoods for the adults with ID, in contrast to the steeper gradient seen in the general population. Adults with ID have increased likelihood of unintended adverse effects, regardless of potential confounds, so clinicians undertaking medication reviews need to consider anticholinergic side effects and cumulative burden across concomitant medications, including in young adults with ID, not just older adults, and particularly women.

Tackling increased risks in older adults with intellectual disability and epilepsy: Data from a national multicentre cohort study

“…Anticholinergic drug burden is associated with negative clinical outcomes including increased contact with services, hospitalisation, and dementia diagnosis [18]. A study of adults with ID and matched controls identified that people with ID have a higher anticholinergic burden and are more likely to be prescribed anticholinergic medication (OR 1.49, 95%CI: 1.38-1.59) [19]. Our study confirms this and further enumerates that those older with ID and epilepsy carry greater risk than their younger peers.…”

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

“…Further details on sampling and linkage have previously been reported. 4 Anticholinergic medications were identi ed using the modi ed Anticholinergic Risk Scale (ARS) which was updated by the authors. 4 The ARS list classi es anticholinergic medicines as moderate (risk category 1), strong (risk category 2), and very strong (risk category 3), and is one of the more conservative anticholinergic burden scales.…”

“…4 Anticholinergic medications were identi ed using the modi ed Anticholinergic Risk Scale (ARS) which was updated by the authors. 4 The ARS list classi es anticholinergic medicines as moderate (risk category 1), strong (risk category 2), and very strong (risk category 3), and is one of the more conservative anticholinergic burden scales. There are numerous anticholinergic burden scales, although there is consensus of a cumulative total score of 3 or greater to be clinically at risk of adverse effects.…”

“…Adults with intellectual disabilities experience an increased risk of adverse effects associated with high anticholinergic burden. [1][2][3][4] Previous literature has focused predominantly on the older adult general population and found high anticholinergic burden to be associated with a range of poor health outcomes including cognitive impairment and dementia; 5 emergency health service use, 6 and all-cause mortality. [7][8][9] Common adverse effects of anticholinergic burden include constipation, dry mouth, blurred vision, cognitive impairment, urinary retention, dry mouth, and increased fall risk.…”

Rating scales to measure adverse effects of medications in people with intellectual disability: a scoping review

“…People with ID are particularly susceptible to polypharmacy due to the extensive medication regimens needed to manage these conditions [4]. Subsequently, people with ID have a high medication burden, especially from anticholinergics, sedatives and psychotropic medications, including antipsychotics [5][6][7][8][9][10][11]. While first-generation antipsychotics are known to cause a range of extrapyramidal symptoms, such as akathisia, tardive dyskinesia (TD) and dystonia, newer generation atypical antipsychotics produce cardiovascular and metabolic adverse effects [12].…”