Psychotropic medication use for adults and older adults with intellectual disability; selective review, recommendations and future directions

The use of psychotropic medication among persons with dementia (PWD) both in nursing home (Wetzels et al., 2011) and community settings (Maust et al., 2016) far exceeds what might be expected based on their limited evidence for benefit (Kales et al., 2015). This relatively high use persists despite years of evidence about the potential harms associated with their use in older adults generally and PWD in particular (e.g. Wang et al., 2001; Schneider et al., 2005). However, the solution to relatively high psychotropic use is not to end all psychotropic use, as there are individual patients for whom use of such medication is appropriate. For example, a policy that defines all antipsychotic use as inappropriate may simply lead to increased use of alternatives with even less evidence of benefit, as suggested by the response to antipsychotics’ black box warning in the United States (Kales et al., 2011).

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298ASSOCIATIONS BETWEEN MEDICATION USE AND FALLS AMONG OLDER ADULTS WITH INTELLECTUAL DISABILITY IN IRELAND

Age and Ageing ◽

10.1093/ageing/afw159.51 ◽

2016 ◽

Vol 45 (suppl 2) ◽

pp. ii1.51-ii12

Author(s):

Sinead Foran ◽

Maire O Dwyer ◽

Mary McCarron ◽

Martin Henman ◽

Philip McCallion

Keyword(s):

Older Adults ◽

Intellectual Disability ◽

Medication Use

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Characteristics and the trajectory of psychotropic medication use in general and antipsychotics in particular among adults with an intellectual disability who exhibit aggressive behaviour

Journal of Intellectual Disability Research ◽

10.1111/jir.12119 ◽

2014 ◽

Vol 59 (1) ◽

pp. 11-25 ◽

Cited By ~ 49

Author(s):

S. Deb ◽

G. Unwin ◽

T. Deb

Keyword(s):

Intellectual Disability ◽

Psychotropic Medication ◽

Aggressive Behaviour ◽

Medication Use

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Psychotropic Medication Use in Older Adults

International Anesthesiology Clinics ◽

10.1097/aia.0000000000000034 ◽

2014 ◽

Vol 52 (4) ◽

pp. 77-94 ◽

Cited By ~ 5

Author(s):

Jason Strauss

Keyword(s):

Older Adults ◽

Psychotropic Medication ◽

Medication Use

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Experiences of psychotropic medication use and decision-making for adults with intellectual disability: a multistakeholder qualitative study in the UK

BMJ Open ◽

10.1136/bmjopen-2019-032861 ◽

2019 ◽

Vol 9 (11) ◽

pp. e032861 ◽

Cited By ~ 2

Author(s):

Rory Sheehan ◽

Angela Hassiotis ◽

André Strydom ◽

Nicola Morant

Keyword(s):

Decision Making ◽

Intellectual Disability ◽

Psychotropic Medication ◽

Stakeholder Involvement ◽

Medication Use ◽

Care Providers ◽

Family Carers ◽

Joint Decisions ◽

The Uk ◽

Medication Decisions

ObjectivesUnderstanding patient and carer perspectives is essential to improving the quality of medication prescribing. This study aimed to explore experiences of psychotropic medication use among people with intellectual disability (ID) and their carers, with a focus on how medication decisions are made.DesignThematic analysis of data collected in individual semistructured interviews.Participants and settingFourteen adults with ID, 12 family carers and 12 paid carers were recruited from specialist psychiatry services, community groups, care providers and training organisations in the UK.ResultsPeople with ID reported being highly compliant with psychotropic medication, based on a largely unquestioned view of medication as important and necessary, and belief in the authority of the psychiatrist. Though they sometimes experienced medication negatively, they were generally not aware of their right to be involved in medication decisions. Paid and family carers reported undertaking a number of medication-related activities. Their ‘front-line’ status and longevity of relationships meant that carers felt they possessed important forms of knowledge relevant to medication decisions. Both groups of carers valued decision-making in which they felt they had a voice and a genuine role. While some in each group described making joint decisions about medication with psychiatrists, lack of involvement was often described. This took three forms in participants’ accounts: being uninformed of important facts, insufficiently included in discussions and lacking influence to shape decisions. Participants described efforts to democratise the decision-making process by gathering information, acting to disrupt perceived power asymmetries and attempting to prove their credibility as valid decision-making partners.ConclusionsStakeholder involvement is a key element of medication optimisation that is not always experienced in decisions about psychotropic medication for people with ID. Forms of shared decision-making could be developed to promote collaboration and offer people with ID and their carers greater involvement in medication decisions.

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Psychotropic and Opioid-Based Medication Use among Economically Disadvantaged African-American Older Adults

Pharmacy ◽

10.3390/pharmacy8020074 ◽

2020 ◽

Vol 8 (2) ◽

pp. 74

Author(s):

Mohsen Bazargan ◽

Sharon Cobb ◽

Cheryl Wisseh ◽

Shervin Assari

Keyword(s):

Older Adults ◽

African American ◽

Back Pain ◽

Psychotropic Medication ◽

Economically Disadvantaged ◽

Severe Pain ◽

Medication Use ◽

Psychotropic Medications ◽

Self Rated Health ◽

African American Older Adults

African-American older adults, particularly those who live in economically deprived areas, are less likely to receive pain and psychotropic medications, compared to Whites. This study explored the link between social, behavioral, and health correlates of pain and psychotropic medication use in a sample of economically disadvantaged African-American older adults. This community-based study recruited 740 African-American older adults who were 55+ yeas-old in economically disadvantaged areas of South Los Angeles. Opioid-based and psychotropic medications were the outcome variables. Gender, age, living arrangement, socioeconomic status (educational attainment and financial strain), continuity of medical care, health management organization membership, sleeping disorder/insomnia, arthritis, back pain, pain severity, self-rated health, depressive symptoms, and major chronic conditions were the explanatory variables. Logistic regression was used for data analyses. Arthritis, back pain, severe pain, and poor self-rated health were associated with opioid-based medications. Pain severity and depressive symptoms were correlated with psychotropic medication. Among African-American older adults, arthritis, back pain, poor self-rated health, and severe pain increase the chance of opioid-based and psychotropic medication. Future research should test factors that can reduce inappropriate and appropriate use and prescription of opioid-based and psychotropic medication among economically disadvantaged African-American older adults.

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Psychotropic medication use and cognition in institutionalized older adults with mild to moderate dementia

International Psychogeriatrics ◽

10.1017/s1041610209008552 ◽

2009 ◽

Vol 21 (02) ◽

pp. 286 ◽

Cited By ~ 21

Author(s):

Laura H. P. Eggermont ◽

Kerst de Vries ◽

Erik J. A. Scherder

Keyword(s):

Older Adults ◽

Psychotropic Medication ◽

Medication Use ◽

Moderate Dementia

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Deprescribing in Older Adults: Is Evidence for Continued Medication Use Generalizable Beyond Age 75?

Innovation in Aging ◽

10.1093/geroni/igaa057.2912 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 802-803

Author(s):

Joshua Niznik

Keyword(s):

Older Adults ◽

Clinical Trials ◽

Medication Use ◽

Advanced Age ◽

Future Directions ◽

Challenges And Opportunities ◽

Potential Benefits ◽

Continued Use ◽

Geriatric Health Services ◽

Interest In Research

Abstract Older adults over the age of 75 are severely underrepresented in many of the clinical trials used to justify the continued use of medications for chronic disease prevention in advanced age. The gaps in evidence in this population have fueled an interest in research to better understand the potential benefits and harms associated with the continued use of medications with uncertain benefit in advanced age. Deprescribing, the intentional reduction or discontinuation of medications, has recently gained traction as an important component of the prescribing process, but raises questions about the safety of stopping medications. This presentation will provide an overview of the evolution of deprescribing research and how this has shaped my career as a geriatric health services researcher. Specifically, I will address early studies that defined the field, challenges and opportunities for studying deprescribing in older adults, and future directions and priorities in deprescribing research.

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