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Drug Burden Index (DBI)

Wei Du, Danijela Gnjidic, Sallie-Anne Pearson, Sarah N Hilmer, Andrew J McLachlan, Fiona Blyth, Rosalie Viney, Grace Joshy, Cathy Day, Emily Banks
OBJECTIVES: To quantify the relationship between home medicines review (HMR) receipt in older adults and sociodemographic, medication-related and health factors. DESIGN: Prospective cohort analysis. SETTINGS, PARTICIPANTS, MEASUREMENTS: Questionnaire data from a population-based cohort study of individuals aged ≥45 years, Sydney, Australia were linked with primary healthcare data, medication and hospitalisation data, to ascertain factors associated with HMR receipt during the period July 2009-June 2014...
February 15, 2019: BMJ Open
Helene G van der Meer, Katja Taxis, Martina Teichert, Fabiënne Griens, Lisa G Pont, Hans Wouters
PURPOSE: To identify the proportion of older adults with a high anticholinergic/sedative load and to identify patient subgroups based on type of central nervous system (CNS)-active medication used. METHODS: A cross-sectional study of a nationwide sample of patients with anticholinergic/sedative medications dispensed by 1779 community pharmacies in the Netherlands (90% of all community pharmacies) in November 2016 was conducted. Patients aged older than 65 years with a high anticholinergic/sedative load defined as having a drug burden index (DBI) greater than 1 were included...
February 12, 2019: Pharmacoepidemiology and Drug Safety
Hans Wouters, Sarah N Hilmer, Danijela Gnjidic, Jos P Van Campen, Martina Teichert, Helene G Van Der Meer, Laura A Schaap, Martijn Huisman, Hannie C Comijs, Petra Denig, Claudine J Lamoth, Katja Taxis
Background: Anticholinergic and sedative medications are frequently prescribed to older individuals. These medications are associated with short-term cognitive and physical impairment, but less is known about long-term associations. We therefore examined over twenty years whether cumulative exposure to these medications was related to poorer cognitive and physical functioning. Methods: Older adult participants of the Longitudinal Aging Study Amsterdam (LASA) were followed from 1992-2012...
January 21, 2019: Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
Nagham Ailabouni, Dee Mangin, Prasad S Nishtala
Background Prolonged use of anticholinergic and sedative medicines is correlated with worsening cognition and physical function decline. Deprescribing is a proposed intervention that can help to minimise polypharmacy whilst potentially improving several health outcomes in older people. Objective This study aimed to examine the feasibility of implementing a deprescribing intervention that utilises a patient-centred pharmacist-led intervention model; in order to address major deprescribing challenges such as general practitioner time constraints and lack of accessible deprescribing guidelines and processes...
January 18, 2019: International Journal of Clinical Pharmacy
Hamish A Jamieson, Prasad S Nishtala, Richard Scrase, Joanne M Deely, Rebecca Abey-Nesbit, Sarah N Hilmer, Darrell R Abernethy, Sarah D Berry, Vincent Mor, Cameron J Lacey, Philip J Schluter
Background: The Drug Burden Index (DBI) calculates the total sedative and anticholinergic load of prescribed medications, and is associated with functional decline and hip fractures in older adults. However, it is unknown if confounding factors influence the relationship between the DBI and hip fractures. The objective of this study is to evaluate the association between the DBI and hip fractures, after correcting for mortality and multiple potential confounding factors. Methods: A competing risk regression analysis conducted on a prospectively recruited New Zealand community-dwelling older population who had a standardized (interRAI) assessment between 1 September 2012 and 31 October 2015, the study's end date...
July 31, 2018: Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
Helene G van der Meer, Hans Wouters, Lisa G Pont, Katja Taxis
OBJECTIVE: To evaluate if a pharmacist-led medication review is effective at reducing the anticholinergic/sedative load, as measured by the Drug Burden Index (DBI). DESIGN: Randomised controlled single blind trial. SETTING: 15 community pharmacies in the Northern Netherlands. PARTICIPANTS: 157 community-dwelling patients aged ≥65 years who used ≥5 medicines for ≥3 months, including at least one psycholeptic/psychoanaleptic medication and who had a DBI≥1...
July 19, 2018: BMJ Open
Catherine J Byrne, Caroline Walsh, Caitriona Cahir, Cristín Ryan, David J Williams, Kathleen Bennett
OBJECTIVES: The Drug Burden Index (DBI) tool quantifies individual exposure to anticholinergic and sedative medications. The DBI has been internationally validated against adverse health outcomes in older people. DBI exposure has not been reported in the Irish older population. This study aimed to: (1) develop a list of drugs with clinically significant anticholinergic and/or sedative effects (DBI medications) relevant to Ireland; (2) examine, using the DBI formula, the prevalence of exposure to DBI medications in Irish older people and (3) explore patient factors associated DBI exposure...
July 6, 2018: BMJ Open
Daniel Sevilla-Sánchez, Núria Molist-Brunet, Javier González-Bueno, Núria Solà-Bonada, Joan Espaulella-Panicot, Carles Codina-Jané
AIM: To evaluate the anticholinergic burden (ACB), the risk factors associated with its onset and the clinical consequences for patients with advanced chronic conditions. METHODS: A 10-month cross-sectional study was carried out in an acute hospital care geriatric unit. Patients with advanced chronic conditions were identified by the NECessity of PALliative care (NECPAL) test. The ACB was established using the Anticholinergic Drug Scale and Drug Burden Index (DBI) tools...
August 2018: Geriatrics & Gerontology International
Angela Mª Villalba-Moreno, Eva Rocio Alfaro-Lara, Aitana Rodriguez-Perez, Daniel Banez-Toro, Susana Sanchez-Fidalgo, Mª Concepcion Perez-Guerrero, Bernardo Santos-Ramos, Mª Dolores Nieto-Martin
Background: Anticholinergic and sedative drugs are associated with adverse events such as cognitive and functional impairment in elderly. The Drug Burden Index (DBI) is a measure of an individual’s total exposure to anticholinergic and sedative drugs. Objetive: The study aimed to evaluate the association between the total DBI and cognitive and functional impairment in patients with multimorbidity. Setting: Patients with multimorbidity enrolled in the IMPACTO project...
March 27, 2018: Current Pharmaceutical Design
Mohammed A Mohammed, Rebekah J Moles, Sarah N Hilmer, Lisa Kouladjian O'Donnel, Timothy F Chen
OBJECTIVE: Medication-related burden (MRB) is a negative experience with medicine, which may impact on psychological, social, physical and financial well-being of an individual. This study describes the development and initial validation of an instrument specifically designed to measure MRB on functioning and well-being-the Medication-Related Burden Quality of Life (MRB-QoL) tool. METHODS: An initial pool of 76-items for MRB-QoL was generated. The link to MRB-QoL survey was sent to a sample of consumers living with at least one chronic medical condition and taking ≥3 prescription medicines on a regular basis...
January 11, 2018: BMJ Open
Hamish A Jamieson, Prasad S Nishtala, Richard Scrase, Joanne M Deely, Rebecca Abey-Nesbit, Martin J Connolly, Sarah N Hilmer, Darrell R Abernethy, Philip J Schluter
BACKGROUND: Adverse outcomes associated with advanced diseases are often exacerbated by polypharmacy. OBJECTIVES: The current study investigated an association between exposure to anticholinergic and sedative medicines and falls in community-dwelling older people, after controlling for potential confounders. METHODS: We conducted a retrospective cross-sectional study of a continuously recruited national cohort of community-dwelling New Zealanders aged 65 years and over...
January 2018: Drugs & Aging
Juliette O'Connell, Éilish Burke, Niamh Mulryan, Claire O'Dwyer, Clare Donegan, Philip McCallion, Mary McCarron, Martin C Henman, Máire O'Dwyer
AIMS: The drug burden index (DBI) is a dose-related measure of anticholinergic and sedative drug exposure. This cross-sectional study described DBI in older adults with intellectual disabilities (ID) and the most frequently reported therapeutic classes contributing to DBI and examined associations between higher DBI scores and potential adverse effects as well as physical function. METHODS: This study analysed data from Wave 2 (2013/2014) of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), a representative study on the ageing of people with ID in Ireland...
March 2018: British Journal of Clinical Pharmacology
Wen-Han Hsu, Yu-Wen Wen, Liang-Kung Chen, Fei-Yuan Hsiao
PURPOSE: No consensus has been reached regarding which anticholinergic scoring system works most effectively in clinical settings. The aim of this population-based cohort study was to examine the association between anticholinergic medication burden, as defined by different scales, and adverse clinical outcomes among older adults. METHODS: From Taiwan's Longitudinal Health Insurance Database, we retrieved data on monthly anticholinergic drug use measured by the Anticholinergic Risk Scale (ARS), the Anticholinergic Cognitive Burden Scale (ACB), and the Drug Burden Index - Anticholinergic component (DBI-Ach) for 116,043 people aged 65 years and older during a 10-year follow-up...
November 2017: Annals of Family Medicine
Kenya Ie, Eric Chou, Richard D Boyce, Steven M Albert
BACKGROUND: Several scales to quantify the impact of potentially harmful medications (PHMs) have been shown to predict mortality and functional decline; however, the effect of PHMs on quality of life (QoL) has not been well-studied. OBJECTIVE: The aims of this study were to investigate an association between PHM use and change in health-related QoL among community-dwelling older adults, and to compare the predictive capacity of PHM scales. METHODS: We conducted a retrospective cohort study using prescription claims data and survey responses...
December 2017: Drugs—Real World Outcomes
Elodie Jean-Bart, Claire Moutet, Virginie Dauphinot, Pierre Krolak-Salmon, Christelle Mouchoux
Background There are several assessment scales to evaluate the risk of falls or the adverse drug reaction risk. Few are sufficiently specific to assess the impact of drug prescriptions on falls in geriatric populations. Objective To define the risk of anticholinergic and sedation-related ADRs in an elderly hospitalized patient population using the Drug Burden Index (DBI), Anticholinergic Drug Scale (ADS), and Sedative Load Model (SLM). Setting Five geriatric university hospital centers in France. Method Multicenter prospective cohort study from 2011 to 2013...
December 2017: International Journal of Clinical Pharmacy
L M J Sanders, T Hortobágyi, G van Staveren, K Taxis, F Boersma, H C Klein, W J R Bossers, C G Blankevoort, E J A Scherder, E A Van der Zee, M J G van Heuvelen
PURPOSE: The Drug Burden Index (DBI) is a tool to quantify the anticholinergic and sedative load of drugs. Establishing functional correlates of the DBI could optimize drug prescribing in patients with dementia. In this cross-sectional study, we determined the relationship between DBI and cognitive and physical functions in a sample of patients with dementia. METHODS: Using performance-based tests, we measured physical and cognitive functions in 140 nursing home patients aged over 70 with all-cause dementia...
December 2017: European Journal of Clinical Pharmacology
Ryohei Sato, Yasumichi Arai, Yukiko Abe, Michiyo Takayama, Hisashi Urushihara
AIM: The objective of this study was to assess the burdens of anticholinergic and sedative drugs in community-living individuals of 85 years of age or older. METHODS: The Tokyo Oldest Old survey on Total Health (TOOTH) is a cohort study designed to assess the physical, mental, and oral health of the community-living oldest old. We investigated the relationships between the anticholinergic/sedative burden and physical/cognitive outcomes. The drug burden was assessed by the Drug Burden Index (DBI)...
2017: Nihon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics
Gao-Jing Ong, Amy Page, Gillian Caughey, Sally Johns, Emily Reeve, Sepehr Shakib
It is not known how clinicians assess polypharmacy or the medication-related characteristics that influence their assessment. The aim of this study was to examine the level of agreement between clinicians when assessing polypharmacy and to identify medication-related characteristics that influence their assessment. Twenty cases of patients with varying levels of comorbidity and polypharmacy were used to examine clinician assessment of polypharmacy. Medicine-related factors within the cases included Beers and STOPP Criteria medicines, falls-risk medicines, drug burden index (DBI) medicines, medicines causing postural hypotension, and pharmacokinetic drug-drug interactions...
June 2017: Pharmacology Research & Perspectives
Nagham Ailabouni, Dee Mangin, Prasad S Nishtala
INTRODUCTION: Targeted deprescribing of anticholinergic and sedative medicines can lead to positive health outcomes in older people; as they have been associated with cognitive and physical functioning decline. This study will examine whether the proposed intervention is feasible at reducing the prescription of anticholinergic and sedative medicines in older people. METHODS AND ANALYSIS: The Standard Protocol Items: Recommendations for Interventional trials (SPIRIT checklist) was used to develop and report the protocol...
April 16, 2017: BMJ Open
Hans Wouters, Helene van der Meer, Katja Taxis
PURPOSE: The Drug Burden Index (DBI) is a non-invasive method to quantify patients' anticholinergic and sedative drug burden from their prescriptions. This systematic review aimed to summarise the evidence on the associations between the DBI and clinical outcomes and methodological quality of studies. METHODS: A search in PubMed and Embase (search terms: 'drug', 'burden', and 'index') was performed and experts were contacted. We excluded publications that did not report empirical results or clinical outcomes...
March 2017: European Journal of Clinical Pharmacology
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