Polypharmacy and medication-related harm in people with disabilities: a narrative review of prevalence, mechanisms and research gaps

Sona Priyanka Auroprem; Roopa Sri Ravichandran; Swetha Durai; Nandhan Auro; Sabeetha Lakshmi Madhavan; Hariharan  Selvam

doi:10.18203/2394-6040.ijcmph20263667

Authors

Sona Priyanka Auroprem Research wing, Care Max Foundation, Puducherry, India https://orcid.org/0009-0008-2902-8548
Roopa Sri Ravichandran Clinical Development Services Agency (CDSA), Translational Health Science and Technology Institute, Faridabad, Haryana, India
Swetha Durai Independent Research Consultant, Tamil Nadu, India https://orcid.org/0009-0000-2293-5016
Nandhan Auro JIPMER https://orcid.org/0009-0007-3767-2440
Sabeetha Lakshmi Madhavan Independent Research Consultant, Tamil Nadu, India https://orcid.org/0009-0000-0720-9534
Hariharan Selvam Department of Orthopedics, Government Medical College, Kozhikode, Kerala, India https://orcid.org/0009-0007-9180-9305

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20263667

Keywords:

Polypharmacy, People with disabilities, Medication safety, Adverse drug events

Abstract

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.

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.

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.

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.

Maher RL Jr, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13(1):57-65.

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.

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.

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.

Klijs B, Nusselder WJ, Looman CW, Mackenbach JP. Contribution of chronic disease to the burden of disability. PLoS One. 2011;6(9):e25325.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Segal JL, Brunnemann SR. Clinical pharmacokinetics in patients with spinal cord injuries. Clin Pharmacokinet. 1989;17(2):109-29.

Mestre H, Alkon T, Salazar S, Ibarra A. Spinal cord injury sequelae alter drug pharmacokinetics: an overview. Spinal Cord. 2011;49(9):955-60.

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.

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).

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.

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.

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.

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.

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.

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.

Tejani AM, Perry TL. Reducing prescribing cascades. Afr J Prim Health Care Fam Med. 2025;17(1):e1-4.

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.

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.

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.

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.

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.

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.

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.

Hignett J. Communication barriers that affect medication adherence in patients with learning disabilities. J Prescr Pract. 2021;3(11):447-52.

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.

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.

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.