Polypharmacy and medication-related harm in people with disabilities: a narrative review of prevalence, mechanisms and research gaps
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20263667Keywords:
Polypharmacy, People with disabilities, Medication safety, Adverse drug eventsAbstract
People with disabilities (PWDs) experience a disproportionately high burden of multimorbidity and long-term medication use, increasing their risk of polypharmacy and medication-related harm. This narrative review synthesised evidence on the prevalence and patterns of polypharmacy, mechanisms contributing to medication-related harm, deprescribing practices, medication optimisation strategies, and research gaps among individuals with disabilities. In accordance with the Scale for the Assessment of Narrative Review Articles (SANRA) guidelines, searches of PubMed, Scopus, Google Scholar, and grey literature were conducted to identify studies published in English from January 2010 to May 2026. Eligible studies included individuals with recognised disabilities and reported outcomes related to polypharmacy, inappropriate prescribing, adverse drug events, medication-related harm, pharmacokinetic changes, or deprescribing. Due to heterogeneity in populations, disability types, and reported outcomes, findings were synthesised narratively. Evidence indicated a high prevalence of polypharmacy among individuals with intellectual and developmental disabilities, spinal cord injury, cerebral palsy, and multiple sclerosis, with substantial medication burdens occurring earlier than in the general population. Psychotropic polypharmacy was particularly prevalent among individuals with intellectual and developmental disabilities. Medication-related harm was influenced by polypharmacy, disability-specific pharmacokinetic alterations, communication barriers, medication errors, fragmented healthcare delivery, and limited continuity of care. Multidisciplinary medication reviews, structured deprescribing, and person-centred medication optimisation showed promise, although evidence remains limited, particularly in low- and middle-income countries. Strengthening medication assessment, deprescribing, accessible communication, caregiver support, and evidence-based prescribing is essential to improve medication safety and promote equitable, person-centred care for people with disabilities.
Metrics
References
World Health Organization. Disability and health [Internet]. Geneva: World Health Organization; 2023 Mar 7. Available fat: https://www.who.int/news-room/fact-sheets/detail/disability-and-health. Accessed on 15 May 2025.
Baumstarck K, Del Duca S, El Ouazzani H, Hamouda I, Beltran Anzola A, Aim MA, et al. Increased life expectancy of people with profound intellectual and multiple disabilities: what does it change for parents? J Appl Res Intellect Disabil. 2025;38(1):e70018. DOI: https://doi.org/10.1111/jar.70018
Muth C, Blom JW, Smith SM, Johnell K, Gonzalez-Gonzalez AI, Nguyen TS, et al. Evidence supporting the best clinical management of patients with multimorbidity and polypharmacy: a systematic guideline review and expert consensus. J Intern Med. 2019;285(3):272-288. DOI: https://doi.org/10.1111/joim.12842
Varghese D, Patel P. Polypharmacy [Internet]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2026 [cited 2026 Jul 13]. Available at: https://www.ncbi.nlm.nih.gov/books/NBK532953/. Accessed on 15 May 2025.
World Health Organization. Medication safety in polypharmacy: technical report [Internet]. Geneva: World Health Organization; 2019 [cited 2026 Jul 13]. Available at: https://www.who.int/publications/i/item/WHO-UHC-SDS-2019.11. Accessed on 15 May 2025.
Davies LE, Spiers G, Kingston A, Todd A, Adamson J, Hanratty B. Adverse outcomes of polypharmacy in older people: systematic review of reviews. J Am Med Dir Assoc. 2020;21(2):181-7. DOI: https://doi.org/10.1016/j.jamda.2019.10.022
Maher RL Jr, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13(1):57-65. DOI: https://doi.org/10.1517/14740338.2013.827660
O'Dwyer M, McCallion P, McCarron M, Henman M. Medication use and potentially inappropriate prescribing in older adults with intellectual disabilities: a neglected area of research. Ther Adv Drug Saf. 2018;9(9):535-57. DOI: https://doi.org/10.1177/2042098618782785
DeCormier Plosky W, Dobbertin K, Rupp K, et al. Excluding people with disabilities from clinical research: eligibility criteria lack clarity and justification. Health Aff (Millwood). 2022;41(10):1423-32. DOI: https://doi.org/10.1377/hlthaff.2022.00520
Alqahtani F, Al Awadh SA, Rasool MF. Exploring the pharmacokinetics of drugs in disabled Saudi patients: a systematic review. Pharmaceuticals (Basel). 2025;18(4):582. DOI: https://doi.org/10.3390/ph18040582
Klijs B, Nusselder WJ, Looman CW, Mackenbach JP. Contribution of chronic disease to the burden of disability. PLoS One. 2011;6(9):e25325. DOI: https://doi.org/10.1371/journal.pone.0025325
Bailie J, Fortune N, Plunkett K, Gordon J, Llewellyn G. A call to action for more disability-inclusive health policy and systems research. BMJ Glob Health. 2023;8(3): e011561. DOI: https://doi.org/10.1136/bmjgh-2022-011561
Erickson SR, Nicaj D, Barron S. Complexity of medication regimens of people with intellectual and developmental disabilities. J Intellect Dev Disabil. 2018;43(3):351-61. DOI: https://doi.org/10.3109/13668250.2017.1350836
Costello A, Hudson E, Morrissey S, Sharma D, Kelly D, Doody O. Management of psychotropic medications in adults with intellectual disability: a scoping review. Ann Med. 2022;54(1):2485-98. DOI: https://doi.org/10.1080/07853890.2022.2121853
Deutsch SI, Burket JA. Psychotropic medication use for adults and older adults with intellectual disability: selective review, recommendations and future directions. Prog Neuropsychopharmacol Biol Psychiatry. 2021;104:110017. DOI: https://doi.org/10.1016/j.pnpbp.2020.110017
McMahon M, Hatton C, Bowring DL. Polypharmacy and psychotropic polypharmacy in adults with intellectual disability: a cross-sectional total population study. J Intellect Disabil Res. 2020;64(11):834-51. DOI: https://doi.org/10.1111/jir.12775
Baethge C, Goldbeck-Wood S, Mertens S. SANRA—a scale for the quality assessment of narrative review articles. Res Integr Peer Rev. 2019;4:5. DOI: https://doi.org/10.1186/s41073-019-0064-8
Dietz N, Alkin V, Agarwal N, Bjurström MF, Ugiliweneza B, Wang D, et al. Polypharmacy in spinal cord injury: matched cohort analysis comparing drug classes, medical complications, and healthcare utilization metrics with 24-month follow-up. J Spinal Cord Med. 2025;48(5):891-900. DOI: https://doi.org/10.1080/10790268.2024.2375892
Whitney DG, Schmidt M, Peterson MD, Haapala H. Polypharmacy among privately insured adults with cerebral palsy: a retrospective cohort study. J Manag Care Spec Pharm. 2020;26(9):1153-61. DOI: https://doi.org/10.18553/jmcp.2020.26.9.1153
Brüggemann F, Gross S, Süße M, Hok P, Strauss S, Ziemssen T, et al. Polypharmacy in patients with multiple sclerosis and the impact on levels of care and therapy units. Front Neurol. 2023;14:1330066. DOI: https://doi.org/10.3389/fneur.2023.1330066
Fuzesi P, Broadfoot K, Lennon M, Jacob SA, Macaden L, Smith A, et al. The burden of managing medicines for older people with sensory impairment: an ethnographic-informed study. Gerontol Geriatr Med. 2024;10:23337214241253410. DOI: https://doi.org/10.1177/23337214241253410
Smith A, Macaden L, Kroll T, Alhusein N, Taylor A, Killick K, et al. A qualitative exploration of the experiences of community dwelling older adults with sensory impairment/s receiving polypharmacy on their pharmaceutical care journey. Age Ageing. 2019;48(6):895-902. DOI: https://doi.org/10.1093/ageing/afz092
Martines F, Salvago P, Lavanco G, Malta G, Plescia F. Association between polypharmacy and self-reported hearing disability: an observational study using ATC classification and HHIE-S-It questionnaire. Audiol Res. 2025;15(5):135. DOI: https://doi.org/10.3390/audiolres15050135
Yoshida K, Lunsky Y, Müller DJ, Desarkar P. Prevalence of psychotropic medication use and psychotropic polypharmacy in autistic adults with or without intellectual disability. J Autism Dev Disord. 2025;55(2):457-71. DOI: https://doi.org/10.1007/s10803-023-06208-y
Espadas C, Ballester P, Londoño AC, Almenara S, Aguilar V, Belda C, et al. Multimorbidity and psychotropic polypharmacy among participants with autism spectrum disorder with intellectual disability. Psychiatry Res. 2020;292:113321. DOI: https://doi.org/10.1016/j.psychres.2020.113321
Lonchampt S, Gerber F, Aubry J-M, Desmeules J, Kosel M, Besson M. Prevalence of polypharmacy and inappropriate medication in adults with intellectual disabilities in a hospital setting in Switzerland. Front Psychiatry. 2021;12:614825. DOI: https://doi.org/10.3389/fpsyt.2021.614825
Segal JL, Brunnemann SR. Clinical pharmacokinetics in patients with spinal cord injuries. Clin Pharmacokinet. 1989;17(2):109-29. DOI: https://doi.org/10.2165/00003088-198917020-00004
Mestre H, Alkon T, Salazar S, Ibarra A. Spinal cord injury sequelae alter drug pharmacokinetics: an overview. Spinal Cord. 2011;49(9):955-60. DOI: https://doi.org/10.1038/sc.2011.58
Badr AF. Exploring barriers faced by community pharmacists in serving patients with disabilities in Saudi Arabia: recommendations for enhancing healthcare provisions. Pharmacy (Basel). 2024;12(5):137. DOI: https://doi.org/10.3390/pharmacy12050137
Doherty AJ, Atherton H, Boland P, Hastings R, Hives L, Hood K, et al. Barriers and facilitators to primary health care for people with intellectual disabilities and/or autism: an integrative review. BJGP Open. 2020;4(3). DOI: https://doi.org/10.3399/bjgpopen20X101030
Gil-Hernández E, Ballester P, Guilabert M, Sánchez-García A, García-Torres D, Astier-Peña MP, et al. Enhancing safe medication use in home care: insights from informal caregivers. Front Med (Lausanne). 2024;11:1494771. DOI: https://doi.org/10.3389/fmed.2024.1494771
Zaal RJ, van der Kaaij ADM, Evenhuis HM, van den Bemt PMLA. Prescription errors in older individuals with an intellectual disability: prevalence and risk factors in the Healthy Ageing and Intellectual Disability Study. Res Dev Disabil. 2013;34(5):1656-62. DOI: https://doi.org/10.1016/j.ridd.2013.02.005
Auroprem SP, Kar SS, Devaraj L, Thulasingam M. Catastrophic health expenditure among households with differently abled children and adolescents in Puducherry, India: a mixed-method study. Front Public Health. 2025;13:1647871. DOI: https://doi.org/10.3389/fpubh.2025.1647871
Poka MS, Chanyandura JT, Witika BA. Challenges faced by blind patients using chronic medication at a tertiary hospital in South Africa. Health SA Gesondheid. 2022;27. DOI: https://doi.org/10.4102/hsag.v27i0.1900
Naik M, Cacodcar JA, Dhupdale NY. Challenges faced by the visually disabled in use of medication, consequences of medication errors and their self-adopted coping strategies at a tertiary care hospital in Goa, India. Int J Community Med Public Health. 2018;5(3):1191-6. DOI: https://doi.org/10.18203/2394-6040.ijcmph20180783
Svitlica BB, Radovanović A, Obrenov L, Hromiš S. Experiences of visually impaired individuals in self-administering prescription medications: a cross-sectional study. J Adv Nurs. 2026;82(6):5980-92. DOI: https://doi.org/10.1111/jan.70223
Tejani AM, Perry TL. Reducing prescribing cascades. Afr J Prim Health Care Fam Med. 2025;17(1):e1-4. DOI: https://doi.org/10.4102/phcfm.v17i1.4929
Khan AM, Lin P, Kamdar N, Mahmoudi E, Clarke P. Continuity of care in adults aging with cerebral palsy and spina bifida: the importance of community healthcare and socioeconomic context. Disabilities (Basel). 2023;3(2):295-306. DOI: https://doi.org/10.3390/disabilities3020019
Adams D, Hastings RP, Maidment I, Shah C, Langdon PE. Deprescribing psychotropic medicines for behaviours that challenge in people with intellectual disabilities: a systematic review. BMC Psychiatry. 2023;23(1):202. DOI: https://doi.org/10.1186/s12888-022-04479-w
Clifford A, Omokanye M, Bagalkote D. Commentary on “Stakeholder experiences of deprescribing psychotropic medicines for challenging behaviour in people with intellectual disabilities.” Tizard Learn Disabil Rev. 2024;29(2):107-13. DOI: https://doi.org/10.1108/TLDR-05-2024-0022
NHS England. Stopping over medication of people with a learning disability and autistic people (STOMP) and supporting treatment and appropriate medication in paediatrics (STAMP) [Internet]. London: NHS England; [cited 2026 Jul 13]. Available from: https://www.england.nhs.uk/learning-disabilities/improving-health/stomp-stamp/. Accessed on 15 May 2025.
Felkai C, Carew JL, Newby D, Cooper J, Croft H. Common ailment and non-prescription medication-related problems faced by people with intellectual disability: findings from medication reviews provided by pharmacists. Res Social Adm Pharm. 2026;22(1):128-34. DOI: https://doi.org/10.1016/j.sapharm.2025.09.001
Hwang M, Zebracki K, Vogel LC. Medication profile and polypharmacy in adults with pediatric-onset spinal cord injury. Spinal Cord. 2015;53(9):673-8. DOI: https://doi.org/10.1038/sc.2015.62
Stortz JN, Lake JK, Cobigo V, Ouellette-Kuntz HMJ, Lunsky Y. Lessons learned from our elders: how to study polypharmacy in populations with intellectual and developmental disabilities. Intellect Dev Disabil. 2014;52(1):60-77. DOI: https://doi.org/10.1352/1934-9556-52.1.60
O'Dwyer M, Peklar J, McCallion P, McCarron M, Henman MC. Factors associated with polypharmacy and excessive polypharmacy in older people with intellectual disability differ from the general population: a cross-sectional observational nationwide study. BMJ Open. 2016;6(4):e010505. DOI: https://doi.org/10.1136/bmjopen-2015-010505
Hignett J. Communication barriers that affect medication adherence in patients with learning disabilities. J Prescr Pract. 2021;3(11):447-52. DOI: https://doi.org/10.12968/jprp.2021.3.11.447
Pharmaceutical Society of Australia. Medicine safety: disability care report [Internet]. Canberra: Pharmaceutical Society of Australia; [cited 2026 Jul 13]. Available at: https://www.psa.org.au/advocacy/working-for-our-profession/medicine-safety/disability-care/. Accessed on 15 May 2025.
Sheehan R, Hassiotis A, Walters K, Osborn D, Strydom A, Horsfall L. Mental illness, challenging behaviour, and psychotropic drug prescribing in people with intellectual disability: UK population based cohort study. BMJ. 2015;351:h4326. DOI: https://doi.org/10.1136/bmj.h4326
Soria Saucedo R, Liu X, Hincapie-Castillo JM, Zambrano D, Bussing R, Winterstein AG. Prevalence, time trends, and utilization patterns of psychotropic polypharmacy among pediatric Medicaid beneficiaries, 1999-2010. Psychiatr Serv. 2018;69(8):919-26. DOI: https://doi.org/10.1176/appi.ps.201700260
Radcliffe E, Servin R, Cox N, Lim S, Tan QY, Howard C, et al. What makes a multidisciplinary medication review and deprescribing intervention for older people work well in primary care? A realist review and synthesis. BMC Geriatr. 2023;23(1):591. DOI: https://doi.org/10.1186/s12877-023-04256-8
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Sona Priyanka Auroprem, Roopa Sri Ravichandran, Swetha Durai, Nandhan Auro, Sabeetha Lakshmi Madhavan, Hariharan Selvam
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
