Psychotropic medication use and obesity among IDD service recipients in 15 states AAIDD 2012, 6/19/2012

WHAT IS NCI? Multi-state collaboration of state DD agencies interested in measuring how well public systems for people with developmental disabilities perform along several areas, including: employment, community inclusion, choice, rights, and health and sa Launched in 1997 in 13 participating states Supported by participating states NASDDDS – HSRI Collaboration NCI 2

WHAT IS NCI? Adult Consumer Survey Family Survey  Adult Family Survey (person lives at home; 18 and older)  Family Guardian Survey (person lives out-of-home; 18 and older)  Children Family Survey (child lives at home; under 18 years old) Provider Survey  Staff Stability System Data  Mortality  Incidents 3 NCI

WHAT IS NCI? Adult Consumer Survey Standardized, face-to-face interview with a sample of individuals receiving services No pre-screening procedures Conducted with adults only (18 and over) receiving at least one service besides case management Takes 50 minutes on average Background section filled out by case managers and workers 4 NCI

DATA Adult Consumer Survey, background section data collection cycle 8,796 individuals 15 states 5 NCI

FINDINGS Demographics 6 NCI 56% 44% Gender Average Age: 42.5 yrs Where people live:

FINDINGS Demographics 7 NCI Race and Ethnicity

FINDINGS Demographics 8 NCI Level of ID Other Diagnoses

FINDINGS Medications Takes medications for mood disorders: 38% Takes medications for anxiety: 29% Takes medications for behavior problems: 25% Takes medications for psychotic disorders: 18% Takes medications for at least one of the above: 53% 9 NCI

FINDINGS Medications Of those who take medications for at least one condition/purpose, how many take meds for 1, 2, 3 and all 4 of them? 10 NCI N = 3,977 Note: this is not the same as the number of medications taken. A person may take one medication for more than one purpose/condition.

FINDINGS Medications and mental illness 49% of people who need support for behavior issues take meds for behavior problems Only 8% of people who do not need support for behavior issues take meds for behavior problems 88% of people with MI or a psychiatric disorder take meds for mood, anxiety, or psychotic disorders BUT 31% of people not diagnosed with MI or a psychiatric disorder also take meds for mood, anxiety, or psychotic disorders Meds for mood or anxiety disorder are more common w/o an MI dx than meds for psychotic disorder 11 NCI

FINDINGS Characteristics of people who take meds 12 NCI Age At least one med: 43.3 years No meds: 41.5 years Diagnoses ASDCP Down Syndrome At least one med:13%10% 5% No meds: 6%20%13% Place of residence InstitutionGroup home Indep home/apt Parent’s At least one med:6%35%18% 22% No meds: 6%19%17% 47%

FINDINGS Obesity and medications 13 NCI Weight Weight and meds 62% overweight or obese No meds: 57% overweight or obese At least one med:67% overweight or obese Odds ratio: 1.49 (p<0.001)

FINDINGS Obesity and medications BUT, personal characteristics (diagnoses, age, mobility) and place of residence may also affect weight, AND, may be related to whether a person is taking medications, SO, need risk-adjustment 14 NCI

FINDINGS Obesity and medications Logistic regression Dependent variable: overweight or obese Independent variable: takes at least one med Controlling for: mobility, residence type, dx of ASD, dx of CP, dx of Down Syndrome, age All control variables are significant at 0.01 level After risk-adjustment: Odds ratio = 1.44 (p-value < 0.001) 15 NCI

CONCLUSIONS 53% take at least one medication for mood/anxiety/behavior/psychotic disorders High percentage of people without an MI diagnosis still take these meds Those who take meds are more likely to live in group homes and less likely to live with parents or relatives Those who take meds are more likely to be diagnosed with ASD and less likely to be diagnosed with CP or Down Syndrome 16 NCI

CONCLUSIONS 62% of people in the study are overweight or obese People who take at least one med are more likely to be overweight or obese This persists even after controlling for personal characteristics and place of residence (odds ratio of 1.44) 17 NCI

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