A Drug Burden Index to Define the Functional Burden of Medications in Older People

Hilmer, Sarah N.

doi:10.1001/archinte.167.8.781

Cited by 604 publications

(715 citation statements)

References 43 publications

(24 reference statements)

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“…The DBI was developed to measure the functional burden of medications [10,11] and the EQ-5D-5L captures physical function (mobility, self-care and usual activities) while the DEMQOL does not. A previous cross-sectional study also found an association between DBI and lower health-related quality of life in older adults with dementia living in residential settings, but did not find an association with PIMs according to the Beers Criteria [21].…”

Section: Discussionmentioning

confidence: 99%

“…DBI exposure for all resident records was calculated as the sum of exposure to each anticholinergic or sedative medication using the equation below [10]:…”

Section: Drug Burden Index and Potentially Inappropriate Medicationsmentioning

confidence: 99%

“…The Drug Burden Index (DBI) is a measure to determine exposure to anticholinergic and sedative medications [10][11][12]. The DBI has been associated with falls and worse functional outcomes in older adults in residential facilities; however, associations with mortality in different populations and settings remain unclear [9,[13][14][15].…”

Section: Introductionmentioning

confidence: 99%

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Associations between the Drug Burden Index, Potentially Inappropriate Medications and Quality of Life in Residential Aged Care

et al. 2018

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Background: Inappropriate polypharmacy may negatively impact quality of life of residents in aged care facilities, but it remains unclear which medications may influence this reduced quality of life.Objective: The objective was to examine whether the Drug Burden Index (DBI) and potentially inappropriate medications (PIMs), were associated with quality of life in older adults living in residential care with a high prevalence of cognitive impairment and dementia.Methods: Cross-sectional analyses of 541individuals recruited from 17 residential aged care facilities in Australia in the Investigating Services Provided in the Residential Environment for Dementia (INSPIRED) study. Quality of life was measured using the EQ-5D-5L (a measure of generic quality of life) and the DEMQOL (a measure developed for use in dementia) completed by the participant or a proxy.Results: In the 100 days prior to recruitment, 83.1% of the participants received at least one anticholinergic or sedative medication included in the DBI and 82.7% received at least one PIM according to the Beers Criteria. Multi-level linear models showed there was a significant association between higher DBI and lower quality of life according to the EQ-5D-5L (β (SE): -0.034 (0.012), p=0.006) after adjustment for potential confounding factors. Increasing numbers of PIMs were also associated with lower EQ-5D-5L scores (-0.030 (0.010), p=0.003) and DEMQOL-Self-Report-Utility scores (-0.020 (0.009), p=0.029). Exposure to both DBI-associated medications and PIMs was associated with lower DEMQOL-SelfReport-Utility scores (-0.034 (0.017), p=0.049).Conclusion: Exposure to anticholinergic and sedative medications and PIMs occurred in over three-quarters of a population of older adults in residential care and was associated with a lower quality of life.  This study provides evidence to support that there is a need for greater adherence to recommendations for appropriate medication use in residential aged care.

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Section: Discussionmentioning

confidence: 99%

“…DBI exposure for all resident records was calculated as the sum of exposure to each anticholinergic or sedative medication using the equation below [10]:…”

Section: Drug Burden Index and Potentially Inappropriate Medicationsmentioning

confidence: 99%

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Associations between the Drug Burden Index, Potentially Inappropriate Medications and Quality of Life in Residential Aged Care

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“…Örneğin Antikolinerjik Risk Skalası (Anticholinergic Risk Scale, ARS), İlaç Yük İndeksi (Drug Burden Index, DBI), Reçete Optimizasyon Yöntemi (Prescribing Optimization Method) bu amaçla kullanılan yöntemlerdir (35)(36)(37).…”

Section: Priscus Listesi (Potentially Inappropiate Medications In Theunclassified

Yaşlılarda doğru ilaç kullanımı

Kerry¹

2015

Ege Tıp Dergisi

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ÖzTüm dünyada olduğu gibi ülkemizde de ortalama ve beklenen yaşam süreleri artmakta, doğum oranları azalmakta ve bununla ilişkili olarak da yaşlı nüfusun sayısı ve oranı artmaktadır. Yaşlı nüfus oranının artmasıyla yaşlılıkta sık görülen hastalıklarla daha fazla karşılaşılmaktadır. Bu durum yaşlı bireylerin sağlık hizmetine başvuruları ve sağlık harcamalarını artırmaktadır. Yaşlı hastalar tedavileri sürecinde çeşitli nedenlerle ilaca ilişkin problemler açısından yüksek risk altındadır. İlaç etkisinde yaşa bağlı olarak gelişen farmakokinetik ve farmakodinamik değişiklikler, yüksek oranda görülen çoklu ilaç kullanımı, çoklu hastalıkların varlığı ve yaşlılıkta görülen geriatrik sendromlar yaşlı bireylerde tedaviyi zorlaştırmaktadır. Yaşlılarda uygun olmayan ilaç kullanımı da oldukça yaygın görülen ciddi bir sorundur. Yaşlı hastalarda kullanımı uygunsuz ilaçlar, yaşlılarda yararlılığı düşük ve zarar verme olasılığı yüksek olan ilaçları kapsamaktadır. Bu bağlamda, önceden belirlenmiş kriterler kullanılarak uygunsuz ilaç kullanımının, polifarmasi uygulamalarının, ilaç etkileşimleri ile advers ilaç reaksiyonlarının saptanması ve engellemesinin yaşlı hastalarda güvenli ve etkili bir tedaviye katkısı olduğu unutulmamalıdır.Anahtar Sözcükler: Akılcı ilaç kullanımı, farmakokinetik, farmakodinamik, polifarmasi, yaşlanma. Abstract Life expectancy is increasing all over the world, as well as in our country. Since the birth rate is decreasing, the population of elderly is relatively increasing. The more increase in the elderly

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“…The Screening Tool for Older Persons' Prescriptions (STOPP) and the Screening Tool to Alert Right Treatment (START) criteria have been developed and validated for European countries with results that indicate they are more sensitive to detecting ADE and prescription errors than the Beers' criteria [O'Mahony et al 2010;Delgado Silveira et al 2009;Lang et al 2009;Ryan et al 2009;Gallagher et al 2008;Topinkova et al 2008]. The Drug Burden Index (DBI) is another risk assessment tool that identifies high-risk medicines by pharmacologic class (anticholinergic and sedative) and calculates an individual's cumulative exposure to these medicines, considering both the number and dose of these medicines [Hilmer et al 2007a]. The recently developed Anticholinergic Risk Scale (ARS) is a cumulative scale that gives weight to anticholinergic medications on a three-point scale (0, no or low risk, to 3, high anticholinergic potential).…”

Section: Risk Assessment Toolsmentioning

confidence: 99%

Medication safety in residential aged-care facilities: a perspective

Wilson

March

Sambrook

et al. 2010

Therapeutic Advances in Drug Safety

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Medication safety must be tailored to the distinctive issues in residential aged-care facilities (RACFs). The health and functional characteristics of their residents are different to those of hospital inpatients and community-dwelling older adults, and there are unique staffing and management issues. Understanding the aetiology and epidemiology of drug-related problems is vital in developing methods to improve patient safety. In this perspective review, we discuss tools that are used to quantify exposure to 'high-risk' medications and their evaluation in residential aged-care settings. Drug withdrawal interventions are described as a potential way to reduce adverse drug events in RACFs. Multidisciplinary professional interventions, education programs and improved communication between health professionals have been shown to improve medication safety in RACFs. Technological advances and other administrative strategies may also improve resident safety. This perspective addresses issues in medication safety facing RACFs and methods to improve the safety of medicines for their residents.

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A Drug Burden Index to Define the Functional Burden of Medications in Older People

Cited by 604 publications

References 43 publications

Associations between the Drug Burden Index, Potentially Inappropriate Medications and Quality of Life in Residential Aged Care

Associations between the Drug Burden Index, Potentially Inappropriate Medications and Quality of Life in Residential Aged Care

Yaşlılarda doğru ilaç kullanımı

Medication safety in residential aged-care facilities: a perspective

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