Identifying opportunities to optimise prescribing in a cohort of older adults with intellectual disability using the OPTIMA-ID tool

Abstract Introduction Older adults with intellectual disability face significant multimorbidity and medication burden that differs from the general population. Subsequently, they often experience polypharmacy, hyperpolypharmacy, psychotropic polypharmacy, and high sedative and anticholinergic burden.1 This has been identified by the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), a nationally representative study of adults with intellectual disability aged 40+, which collects data at three-yearly intervals, referred to as ‘waves.’ Tools for optimising prescribing in the general population are not attuned to the medication issues of people with intellectual disability. Optimising Pharmaco-Therapy and Improving Medication for Ageing with Intellectual Disability (OPTIMA-ID) is a newly published set of 67 criteria for identifying potentially inappropriate prescribing (PIP), and therefore both pharmacological and non-pharmacological opportunities for medicines optimisation.2 Aim The aim of this retrospective study was to assess prescribing in the IDS-TILDA cohort using OPTIMA-ID, a tool designed for the unique medication and health issues faced by older adults with intellectual disability. Methods Variables and relevant medication data from Wave 5 of IDS-TILDA were gathered from participants and the OPTIMA-ID criteria were applied to identify PIP in this cohort. Wave 5 was chosen, as the most recent round of data collection, to provide a picture of current prescribing practice. The advanced function package ‘tidyverse’ for R was used for data tidying, wrangling and manipulation. Functions were built in R to identify participants who reported conditions, clinical characteristics and medications that could be optimised. Results In Wave 5 there were 762 participants; 53% (n = 407) were female, 24% (n = 183) were 50 years, and 48% (n = 363) were 50–64 years. The median number of medicines prescribed was 5 (interquartile range, IQR 3–8, range 0–27). Of 67 OPTIMA-ID criteria, 78% (n = 52) were applicable to Wave 5 IDS-TILDA data. There was a median of 2 instances of PIP identified per participant (IQR 1–3, range 0–9). The most commonly identified instance of PIP was a lack of non-pharmacological interventions for common health conditions (n = 273) which accounted for 15.3% of PIP identified in the cohort. Of the criteria that specifically detect potentially inappropriate medicines or potential prescribing omissions, the most prevalent were within the domain of the alimentary tract and metabolism: not using osmotic or bulk-forming laxatives first line for constipation (n = 88), prescribing of proton pump inhibitors at high doses for longer than 8 weeks (n = 70), and prescribing of drugs likely to cause constipation in patients with chronic constipation (n = 66). Conclusion OPTIMA-ID identifies PIP and highlights opportunities to improve the pharmacotherapy and care of older adults with intellectual disability. A strength of this work is that it analyses data from a nationally representative sample of older adults with intellectual disability. A limitation is a lack of independent verification of self-reported clinical characteristics by participants’ clinical teams. Further work is needed to assess the use of this new tool by healthcare professionals and to identify associations between PIP according to OPTIMA-ID and healthcare outcomes for people with intellectual disability.