Concerns raised as over half of adults with intellectual disability taking medication for mental-health conditions

Most older adults with an intellectual disability are taking medication that affects their mental state, raising concerns about potentially inappropriate prescribing, a study has found.

Six in 10 reported taking at least one psychotropic medication for mental-health conditions over a 10-year period, according to the study by scientists at Trinity College Dublin.

Psychotropic medications include antidepressants, anti-anxiety medications, stimulants, antipsychotics and mood stabilisers. While these medicines are critical to treat mental-health conditions and improve quality of life, their inappropriate use can lead to side effects such as falls and chronic constipation as well as impacting activity levels.

The research findings are based on data from people with intellectual disability participating in The Irish Longitudinal Study on Ageing, known as Tilda.

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Four in 10 participants reported taking antipsychotics, the most widely used psychotropic across the 10 years of data.

There was a notable increase in antidepressant use over time, from 26.2 per cent in 2010 to 31.9 per cent in 2020, with women more likely to report use of these medications.

Prof Mary McCarron, principal investigator, described the finding of high level of use of these medications as concerning.

“It challenges us to consider and prescribe alternatives where appropriate. Regular reviews are imperative as well as greater use of non-pharmacological approaches and wider access to multidisciplinary team members,” she said.

While half of older adults with intellectual disability reported a doctor’s diagnosis of mental illness, co-principal investigator Prof Máire O’Dwyer said positive trends are emerging over time.

These include a significant decrease in the use of anxiety medicines (anxiolytics), from 25 per cent to 17.6 per cent, while use of sleeping tablets (hypnotic medicines) fell from 14 per cent to 9 per cent.

Despite the high use of psychotropics, consumption fell among younger participants over successive waves of the study; from 40.5 per cent of 40-49-year-olds in 2010 and to 26.6 per cent in this age-group a decade later.

The decreasing use of medication in this age group, and of sleeping tablets and sedatives generally, is reassuring, according to the study’s authors.

“What is critical is that people with intellectual disability often don’t have access to non-pharmacological supports they need, like psychology, speech and language therapy. Only 40 per cent of those with behaviours of concern and no mental illness had access to such services,” Prof O’Dwyer said.

Psychotropic polypharmacy (the use of two or more medicines together) was associated with a higher level of dependence on others for daily activities, but not with falls, chronic constipation or dementia. Initiatives to address medication concerns in this group will likely benefit all older people, especially those with dementia, the study says.

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