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

Ward, L. M. , Stanley, B. , Greenlaw, N. , Cooper, S.-A. , Pacitti, C., Henderson, A. , Gibson, J. and Kinnear, D. (2021) Risk of anticholinergic burden in adults with intellectual disabilities: a Scottish retrospective cohort study of n = 17 220. Journal of Intellectual Disability Research, 65(9), pp. 813-830. (doi: 10.1111/jir.12861) (PMID:34169610)

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.

• Item Type: Articles
• Additional Information: The authors would like to acknowledge the financial support of the Baily Thomas Charitable Fund (Registered Charity number 262334).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Stanley, Miss Bethany and Ward, Dr Laura and Greenlaw, Miss Nicola and Gibson, Professor John and Cairns, Professor Deborah and Henderson, Mrs Angela and Cooper, Professor Sally-Ann
• Authors: Ward, L. M., Stanley, B., Greenlaw, N., Cooper, S.-A., Pacitti, C., Henderson, A., Gibson, J., and Kinnear, D.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Dental School
• Journal Name: Journal of Intellectual Disability Research
• Publisher: Wiley
• ISSN: 0964-2633
• ISSN (Online): 1365-2788
• Published Online: 25 June 2021
• Copyright Holders: Copyright © 2021 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd
• First Published: First published in Journal of Intellectual Disability Research 65(9): 813-830
• Publisher Policy: Reproduced in accordance with the publisher copyright policy

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