MEdication Management in older people with Intellectual Disabilities (MEMID): a scoping review
Authors: Gangannagaripalli J , Yaakob S , Watson M 
Published: April 2022

Abstract

Introduction
Globally, around 1 in 100 adults have intellectual disabilities (ID) (synonymous with learning disability in the UK) (1) yet their needs in terms of healthcare in general and medication management in particular, are under-researched. People with ID have more comorbidities compared with those without ID and around one third of older people (≥ 50 years) with ID (OPwID) have two or more chronic conditions, putting them at risk of polypharmacy (use of multiple medicines) (2).

Aim
To undertake a scoping review to gather evidence on the barriers and facilitators in the medication management of OPwID from a multi-stakeholder (patient, carer and healthcare professional) perspective.

Methods
Standard scoping review methods were used. Electronic databases (Medline, PsycINFO) were searched from 2011-2021 using a range of search terms. Studies were included if they involved: OPwID without dementia (all types); healthcare professionals or caregivers caring for individuals with ID; problems related to medication use. The review was restricted to studies in the English language.
The PRISMA-ScR checklist and reporting standards was used to conduct and report the review. Independent duplicate screening and data extraction was undertaken. The quality of studies was not formally assessed. A narrative synthesis was conducted to summarise the results and included barriers and facilitators associated with medicines management from patients’/carers’ and professionals’ perspectives.

Results
Eight studies were included, of which seven used qualitative methods. The majority of studies were undertaken in Europe ((the Netherlands (2), Norway (1), Belgium (1), UK (3)) and one was conducted in the US.
Patients/carers reported several barriers/facilitators:
The most cited barriers to medication management of OPwID from professionals’ perspective included: limited knowledge of, and training about, ID; nonadherence to guideline recommendation; and lack of coordination between different professionals in multidisciplinary teams.

Conclusion/Discussion
The review was restricted to two databases and the English language due to resource- and time-constraints. All the included studies were conducted in developed countries with different healthcare settings/practice. As such, the findings might not be generalisable to other less/under-developed countries or settings.
There is limited empirical evidence regarding the medication management of OPwID, in particular, facilitators to medicines management from professionals’ perspective. OPwID are a highly vulnerable population for whom medications have an important role in managing their multiple morbidities. This review highlights an evidence gap regarding the medication management of these individuals. The results will be used to inform the development of personalised intervention(s) to improve the safe and effective use of medication in this population.

References
(1) Maulik PK, Mascarenhas MN, Mathers CD, Dua T, Saxena S. Prevalence of intellectual disability: a meta-analysis of population-based studies. Res Dev Disabil. 2011 Mar 1;32(2):419-36.
(2) Hermans H, Evenhuis HM. Multimorbidity in older adults with intellectual disabilities. Res Dev Disabil. 2014;35(4):776–83.