Prescription errors in older individuals with an intellectual disability: Prevalence and risk factors in the Healthy Ageing and Intellectual Disability Study

Prescribing pharmacotherapy for older individuals with an intellectual disability (ID) is a complex process, possibly leading to an increased risk of prescription errors. The objectives of this study were (1) to determine the prevalence of older individuals with an intellectual disability with at least one prescription error and (2) to identify potential risk factors for these prescription errors (age, gender, body mass index (BMI), frailty index, level of intellectual disability and living situation). The study population consisted of 600 older (≥50 years) individuals with an ID using one or more drugs who were randomly selected from the study cohort of the Healthy Ageing and Intellectual Disability (HA-ID) Study. The medication used at the time of measurement was screened for errors by a hospital pharmacist/clinical pharmacologist and a Master's student pharmacy using consensus methodology. Participants with one or more prescription errors were compared to participants without prescription errors by multivariate logistic regression to identify potential risk factors. The prevalence of individuals with one or more prescription errors was 47.5% (285 of 600 individuals; 95% confidence interval (CI) 43–52%). Relevant errors, defined as errors that actually do require a change of pharmacotherapy, were identified in 26.8% of the individuals (161 of 600 individuals; 95% CI 23–30%). Higher age (adjusted odds ratio (ORadj) 1.03; 95% CI 1.01–1.06), less severe intellectual disability (moderate: ORadj 0.48; 95% CI 0.31–0.74 and severe: ORadj 0.56; 95% CI 0.32–0.98), higher BMI (ORadj 1.04; 95% CI 1.01–1.08), higher frailty index (0.39–0.54: ORadj 2.4; 95% CI 1.21–4.77 and ≥0.55: ORadj 3.4; 95% CI 1.03–11.02), polypharmacy (ORadj 8.06; 95% CI 5.59–11.62) and use of medicines acting on the central nervous system (ORadj 3.34; 95% CI 2.35–4.73) were independently associated with the occurrence of prescription errors. Interventions targeted to high risk patients should be designed and implemented to improve pharmacotherapy in older individuals with an intellectual disability.

► Drug prescribing to older individuals with an intellectual disability (ID) is complex.
► The prevalence of individuals with prescription errors in this population is 47.5%.
► Relevant errors were identified in 26.8% of the individuals.
► Age, level of ID, Body Mass Index and frailty index are potential risk factors for errors.
► Polypharmacy and drugs for the nervous system are also associated with errors.