Optimising Medication Use in People with Intellectual Disabilities

Dear Colleagues,

People with intellectual disabilities receive more medications than most other groups. This is driven by the nature of the disability, multiple morbidity, the need for polypharmacy and a reluctance to depresrcribe. Acute illnesses and their management may destabilise the patient’s medication therapy. Multiple morbidity and the need for polypharmacy are associated with competing and conflicting clinical needs, such as epilepsy and mental health conditions which may require the use of high risk medications and combinations of medications. Prescribing casacades may be inadvertantly created with adverse effects such as constipation being exacerbated by cumulative anticholinergic burden. There limited tools available to assess the effects of medications and the risk of diagnostic overshadowing further complicates the situation. People with intellectual disabilities may find some medications difficult to use, such as inhalers for respiratory conditions. Communication difficulties may increase with age and the ability of healthcare professionals and others caring for people with intellectual disabilities may not be sufficient to meet the needs of the patient in the particular setting. This does not facilitate a high standard of assessment nor of regular mutlidisciplinary medication reviews by adequately qualified and experienced professionals. While deprescribing is being actively pursued with other patient groups, the balancing of the benefits and risks of medications in people with intellectual difficulties are not being researched as intensively.

Although there have been improvements in the care of people with intellectual disabilities and their life expectancy has increased, they are still more likely than the rest of the population to experience premature mortality. The management of their conditions and symptoms with medication is a considerable challenge. In this special issue we invite colleagues to contribute the results of their research and to share their experiences of tackling medication optimisation in people with intellectual disabilities.

Prof. Dr. Martin C Henman
Prof. Dr. Maire O’Dwyer
Guest Editors

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