Factors associated with high anticholinergic burden in aging adults with intellectual disabilities:a cross-sectional study

Background: Anticholinergic (AC) medications are associated with cognitive and functional decline in older people, with risk of adverse outcomes increasing with increasing AC exposure. Older people with intellectual disabilities are at increased risk of high AC exposure owing to higher prevalence of multimorbidity, particularly psychiatric morbidities. Objectives: The aims of this study were to determine individual’s AC exposure using the AC cognitive burden (ACB) scale, identify therapeutic classes contributing to burden and determine clinical and demographic factors associated with two levels of AC exposure (ACB score 1–4, ACB 5+). Methods: Cross-sectional (self-report/proxy report)medication data were drawn from Wave 1 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing, a study on ageing of 753nationally representative people with ID aged over40 randomly selected from the National Intellectual Disability Database. Medication data were available for 736 (98%). Each individual’s cumulative AC exposure was calculated using the ACB. Multinomiallogistic regression was performed identifying clinical and demographic factors associated with ACB score1–4, and ACB 5+. Results: In the eligible population of 736 participants(mean (±SD) age 54.1 (±8.8) years,55% female), 522(70.9%) were exposed to an ACB medicine (ACB 1+); 214 (29%) had an ACB score of 5+; mean total ACB score= 4.5 (±3.0). Antipsychotics accounted for35.6% of the cumulative ACB score. Age over 65yearswas associated with increased likelihood of both levels of AC exposure (ACB 1–4—adjusted OR 3.28; 95%CI 1.49–7.25, ACB 5+—adjusted OR 3.08; 95%CI1.21–7.63) and having a mental health condition(ACB 1–4—adjusted OR 9.79; 95%CI 5.63–17.02, ACB 5+—adjusted OR 23.74; 95%CI 12.29–45.83). Conclusions: Using a simple cumulative measure proved an effective means to capture total burden and established that AC exposure was high and associated with older age and mental health morbidity. This highlights need for comprehensive medication reviews for older people with intellectual disabilities.

Relationship fading in business-to-consumer context

The objective of this thesis is to develop a better understanding of the relationship fading phenomenon in business-to-consumer context. Fading relates to a gradual decline in consumer’s willingness to continue a relationship with a company. Therefore, understanding the fading process may help to elucidate the ‘unexplained’ relationship dissolution and customer defection. Led by an assumption that a relationship between a consumer and a brand is like the one between individuals, the thesis proposes that the trajectory of relationship fading reflects the disaffection processes similar to the ones suggested in marital and romantic relationships between individuals. The approach taken to answering this research question is a multi-study approach. This type of approach allows addressing each individual research question independently, using the most appropriate research methods. As a result, the thesis comprises three adjacent studies. All three studies are linked and together contribute to a better understanding of the relationship fading process, which is the main topic of the thesis. Based on the results from the first study, a set of boundary conditions of relationship fading is identified. The results of the second study suggest that predictors of relationship fading stage can be uncovered. Thirdly, different restoration techniques are explored, aiming to describe their effectiveness in various relationship fading stages. Individual objectives of the three studies are accomplished. All three studies contribute to achieving the overall objective of the thesis, namely to developing a better understanding of the phenomenon of relationship fading.