Publication:

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

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.