Drug burden index score and functional decline in older people.

Intramural Research Program, National Institute on Aging, Baltimore and Bethesda, MD, USA.
The American journal of medicine (Impact Factor: 5.3). 12/2009; 122(12):1142-1149.e1-2. DOI: 10.1016/j.amjmed.2009.02.021
Source: PubMed

ABSTRACT The Drug Burden Index (DBI), a measure of exposure to anticholinergic and sedative medications, has been independently associated with physical and cognitive function in a cross-sectional analysis of community-dwelling older persons participating in the Health, Aging and Body Composition study. Here we evaluate the association between DBI and functional outcomes in Health, Aging and Body Composition study participants over 5 years.
DBI was calculated at years 1 (baseline), 3, and 5, and a measure of the area under the curve for DBI (AUCDB) over the whole study period was devised and calculated. Physical performance was measured using the short physical performance battery, usual gait speed, and grip strength. The association of DBI at each time point and AUCDB with year 6 function was analyzed in data from participants with longitudinal functional measures, controlling for sociodemographics, comorbidities, and baseline function.
Higher DBI at years 1, 3, and 5 was consistently associated with poorer function at year 6. On multivariate analysis, a 1-unit increase in AUCDB predicted decreases in short physical performance battery score of .08 (P=.01), gait speed of .01 m/s (P=.004), and grip strength of .27 kg (P=.004) at year 6.
Increasing exposure to medication with anticholinergic and sedative effects, measured with DBI, is associated with lower objective physical function over 5 years in community-dwelling older people.

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    ABSTRACT: AimTo investigate associations between drugs with anticholinergic effects (DACEs) and cognitive impairment, falls and all-cause mortality in older adults.MethodsA literature search using CINAHL, Cochrane Library, Embase, and PubMed databases was conducted for randomised controlled trials, prospective and retrospective cohort and case-control studies examining the use of DACEs in subjects ≥65 years with outcomes on falls, cognitive impairment and all-cause mortality. Retrieved articles were published on or before June 2013. Anticholinergic exposure was investigated using drug class, DACE scoring systems (anticholinergic cognitive burden scale, ACB; anticholinergic drug scale, ADS; anticholinergic risk scale, ARS; anticholinergic component of the drug burden index, DBIAC) or assessment of individual DACEs. Meta-analyses were performed to pool the results from individual studies.ResultsEighteen studies fulfilled the inclusion criteria (total 124,286 participants). Exposure to DACEs as a class was associated with increased odds of cognitive impairment (OR 1.45, 95%CI 1.16-1.73). Olanzapine and trazodone were associated with increased odds and risk of falls (OR 2.16, 95%CI 1.05-4.44; RR 1.79, 95%CI 1.60-1.97, respectively), but amitriptyline, paroxetine and risperidone were not (RR 1.73, 95%CI 0.81-2.65; RR 1.80, 95%CI 0.81-2.79; RR 1.39, 95%CI 0.59-3.26, respectively). A unit increase in the ACB scale was associated with a doubling in odds of all-cause mortality (OR 2.06, 95%CI 1.82-2.33) but there were no associations with the DBIAC (OR 0.88, 95%CI 0.55-1.42) or the ARS (OR 3.56, 95%CI 0.29-43.27).Conclusions Certain individual DACEs or increased overall DACE exposure may increase the risks of cognitive impairment, falls and all-cause mortality in older adults.
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    04/2014; 1:10. DOI:10.3389/fmed.2014.00010

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