Older adults with intellectual, developmental disabilities take more psychiatric meds

Older individuals with intellectual and developmental disabilities were more likely to take more psychiatric medications and have more medical conditions, according to study results published in The American Journal of Geriatric Psychiatry.

However, this patient population reported fewer psychiatric diagnoses.

“Information on risk factors for development of psychiatric disorder in adults with [intellectual and developmental disabilities] remains somewhat limited,” Elizabeth Wise, MD, of the department of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine, and colleagues wrote. “Advanced age and presence of physical disability have been found to be associated with psychiatric illness in individuals with [intellectual and developmental disabilities] in some investigations, while other studies have found attenuated odds of psychotic, affective and anxiety disorders in oldest age groups compared [with] youngest age groups. The overall contribution of medical conditions to mental health has received some attention, but the relationship to age has not been thoroughly examined.”

The researchers sought to evaluate age-related differences in the mental health presentation of adults with intellectual and developmental disabilities by analyzing fully de-identified data of adults aged 30 year or older, extracted from the de-identified database the Systemic, Therapeutic, Assessment, Resources and Treatment (START) Information Reporting System. They obtained data on psychiatric diagnoses, service use, recent stressors and challenging behaviors via caregiver and START team documents. They conducted T-tests, Mann Whitney U tests, chi-squared tests and multinomial logistic regression models to compare 1,188 individuals aged 30 to 49 years with 464 individuals aged 50 years or older.

Results showed more medical conditions and fewer reported psychiatric conditions among older adults, who were more likely to be taking more psychiatric medications compared with younger adults, after the researchers adjusted for demographic variables, disability level and number of recent stressors. Those aged 50 years or older had lower rates of lifetime psychiatric diagnoses, psychiatric hospitalization, emergency service use and incarceration.

“Future prospective and population-based studies of older adults with [intellectual and developmental disabilities] are needed to evaluate how psychiatric illnesses, health issues and medication use evolve with aging,” Wise and colleagues wrote. “Examination of resilience in older individuals with [intellectual and developmental disabilities] could help identify ways to mitigate morbidity and mortality and improve quality of life. Other areas of potential research include ways to minimize polypharmacy in adults with [intellectual and developmental disabilities] through education and multidisciplinary medication reviews, as well as the development of programs to target nutritional supports and exercise to improve psychiatric health.”