Factors associated with high anticholinergic burden in aging adults with intellectual disabilities: a cross-sectional study

Maire O'Dwyer, Ian Maidment, Philip McCallion, Mary McCarron, Martin Henman, Kathleen Bennett, Jure Peklar

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Anticholinergic (AC) medications are associated with cognitive and functional decline in older people, with risk of adverse outcomes increasing with increasing AC exposure. Older people with intellectual disabilities are at increased risk of high AC exposure owing to higher prevalence of multimorbidity, particularly psychiatric morbidities.
Objectives: The aims of this study were to determine individual’s AC exposure using the AC cognitive burden (ACB) scale, identify therapeutic classes contributing to burden and determine clinical and demographic factors associated with two levels of AC exposure (ACB score 1–4, ACB 5+).
Methods: Cross-sectional (self-report/proxy report)medication data were drawn from Wave 1 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing, a study on ageing of 753nationally representative people with ID aged over40 randomly selected from the National Intellectual Disability Database. Medication data were available for 736 (98%). Each individual’s cumulative AC exposure was calculated using the ACB. Multinomiallogistic regression was performed identifying clinical and demographic factors associated with ACB score1–4, and ACB 5+.
Results: In the eligible population of 736 participants(mean (±SD) age 54.1 (±8.8) years,55% female), 522(70.9%) were exposed to an ACB medicine (ACB 1+); 214 (29%) had an ACB score of 5+; mean total ACB score= 4.5 (±3.0). Antipsychotics accounted for35.6% of the cumulative ACB score. Age over 65yearswas associated with increased likelihood of both levels of AC exposure (ACB 1–4—adjusted OR 3.28; 95%CI 1.49–7.25, ACB 5+—adjusted OR 3.08; 95%CI1.21–7.63) and having a mental health condition(ACB 1–4—adjusted OR 9.79; 95%CI 5.63–17.02, ACB 5+—adjusted OR 23.74; 95%CI 12.29–45.83).
Conclusions: Using a simple cumulative measure proved an effective means to capture total burden and established that AC exposure was high and associated with older age and mental health morbidity. This highlights need for comprehensive medication reviews for older people with intellectual disabilities.
Original languageEnglish
Article number145
Pages (from-to)84
Number of pages1
JournalPharmacoepidemiology and Drug Safety
Volume24
Issue numberS1
DOIs
Publication statusPublished - 30 Sep 2015
Event31st International Conference on Pharmacoepidemiology and Therapeutic Risk Management - Boston, MA, United States
Duration: 22 Aug 201526 Aug 2015

Bibliographical note

Special Issue: Abstracts of the 31st International Conference on Pharmacoepidemiology and Therapeutic Risk Management, August 22–26, 2015, Boston, MA (US).

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