Association of the Drug Burden Index (DBI) exposure with outcomes: A systematic review

Journal of the American Geriatrics Society, Год журнала: 2023, Номер 72(2), С. 589 - 603

Опубликована: Ноя. 25, 2023

Abstract Background The Drug Burden Index (DBI) measures an individual's total exposure to anticholinergic and sedative medications. This systematic review aimed investigate the association of DBI with clinical prescribing outcomes in observational pharmaco‐epidemiological studies, effect on functional pre‐clinical models. Methods A search nine electronic databases, citation indexes gray literature was performed (April 1, 2007–December 31, 2022). Studies that reported primary data or conducted any setting humans aged ≥18 years animals were included. Quality assessment using Joanna Briggs Institute critical appraisal tools Systematic Review Centre for Laboratory animal Experimentation risk bias tool. Results Of 2382 studies screened, 70 met inclusion criteria (65 humans, five animals). In included function ( n = 56), cognition 20), falls 14), frailty 7), mortality 9), quality life 8), hospitalization length stay 5), readmission 1), other 15) 2). higher significantly associated increased (11/14, 71%), poorer (31/56, 55%), (11/20, 55%) related outcomes. Narrative synthesis used due significant heterogeneity study population, setting, type, definition DBI, outcome measures. could not be pooled heterogeneity. animals, 18), 2), 1). a caused frailty. Conclusions may decreased cognition. Higher inconsistently mortality, stay, frailty, reduced life. Human findings respect are supported by preclinical interventional studies. as tool identify older adults at harm.

Язык: Английский

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Dynamic changes in medication burden leading to fall and hospital readmissions in older adults: Toward a strategy for improving risk and managing costs

Journal of Managed Care & Specialty Pharmacy, Год журнала: 2025, Номер 31(1), С. 96 - 100

Опубликована: Янв. 1, 2025

The majority of a health plan's performance and designated Star Rating is related to medication-related behavior, eg, medication adherence, review, reconciliation, that are intricately adverse drug events (ADEs). Altered pharmacodynamics pharmacokinetics owing aging make older adults more vulnerable ADEs like falls, fractures, hospitalizations, mortality. Prevention avoidable risk factors such as burden can help maintain quality life. Studies multiple populations have established index (DBI), dose-dependent measure anticholinergic sedative burden, be strongly associated with worsening vertigo, dizziness, balance, which all predicate falls. mean difference in DBI greater than 0.1 provides predictive power for events, falls 30-day readmission rates. Inclusion delta metric especially on an electronic medical record has the potential reduce fall incidence outcomes hospitalizations death; this presents opportunity improve Centers Medicare & Medicaid Services Ratings by using meaningful tools foster engagement among informed active beneficiaries. We believe information extremely relevant real-world decision-making care professionals, specifically when changes dynamic happen very quickly. Moreover, managed organizations now dedicated eliciting deeper understanding mitigation social inequalities use consequences. Among proposed solutions includes tailoring prescription utilization management decrease incidences complications unintended costs. Understanding relationship between exposures causing costs third-party payments remains vital because United States, approximately one-third hospital admissions occur ADEs. This achieved emphasizing equitable therapy initiatives minimize racial disparities affect financial these patients. Importantly, approach becomes even critical systems increasingly emphasize star ratings, reflect delivered By prioritizing metrics we ensure not only clinically effective but also focused improving patients' overall well-being. Lastly, future directions, timely application advanced technologies artificial intelligence machine learning analyzing could enhance our ability predict value adjustments their correlation other These process vast amounts data quickly accurately, identifying patterns risks might otherwise go unnoticed.

Язык: Английский

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Anticholinergic burden: First comprehensive analysis using claims data shows large variation by age and sex

PLoS ONE, Год журнала: 2021, Номер 16(6), С. e0253336 - e0253336

Опубликована: Июнь 30, 2021

The cumulative effect of medication inhibiting acetylcholine activity-also known as anticholinergic burden (AB)-can lead to functional and cognitive decline, falls, death. Given that studies on the population prevalence AB are rare, we aimed describe it in a large unselected sample.Using German Pharmacoepidemiological Research Database (GePaRD) with claims data from ~20% analyzed outpatient drug dispensations 2016. Based Anticholinergic Cognitive Burden (ACB) scale, classified persons into four categories determined continuous variable.Among 16,470,946 (54% female), clinically relevant (ACB≥3) was 10% (women) 7% (men). Below age 40 highest ≤18 years (6% both sexes). At older ages (50-59 vs. 90-99 years), ACB≥3 increased 26% (men) 32% (women). Medication classes contributing differed by age: antihistamines, antibiotics, glucocorticoids (≤19 antidepressants (20-49 antidepressants, cardiovascular medication, antidiabetics (50-64 additionally for urinary incontinence/overactive bladder (≥65 years). dispensed general physicians contributed most AB.Although is particularly common persons, younger groups up 7%. risks associated targeted interventions at prescriber level needed. Furthermore, should be explored.

Язык: Английский

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Anticholinergic Burden, Sleep Quality and Health Outcomes in Malaysian Aged Care Home Residents

Pharmacy, Год журнала: 2019, Номер 7(4), С. 143 - 143

Опубликована: Окт. 23, 2019

The use of anticholinergic medications by residents in aged care homes is associated with increased risk adverse effects. These include cognitive impairment, sleep disturbances, and falls, necessitate healthcare visits the burden on systems. objective this study was to investigate associations between health outcomes such as independence activities for daily living, frailty, quality life, quality. conducted among Malaysian homes, 60 years above. Anticholinergic calculated using Cognitive Burden (ACB) scale. Health outcome measures included independence, assessed Katz Activities Daily Living scale (Katz ADL); Older People's Quality Life Questionnaire (OPQOL); Groningen Frailty Index (GFI); quality, measured Pittsburg Sleep (PSQI). Just over one-third (36%) population exposed at least one medication effect. An frailty (p = 0.031), latency 0.007), disturbances 0.015). Further studies are required assess effect prolonged exposure outcomes.

Язык: Английский

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Association between Statin Use and Balance in Older Adults

International Journal of Environmental Research and Public Health, Год журнала: 2020, Номер 17(13), С. 4662 - 4662

Опубликована: Июнь 29, 2020

Background: Several medications have been associated with an increased risk of balance deficits and greater likelihood to sustain a fall, representing large health economic issue. Statins are regularly prescribed prevent strokes heart attacks, but their impact on is unknown. The aim this paper was determine whether statin use poorer performances in older adults. Methods: All participants, one group taking statins (n = 34), the other not 31), completed assessment eyes closed opened MatScan Pressure Sensing Mat. Center (CoP) velocity, peak-to-peak distance, standard deviation were collected both anteroposterior (AP) mediolateral (ML) directions. Multiple linear regression analyses performed for each outcome, testing status as predictor controlling appropriate factors including participants characteristics, lipid profile, cardiovascular disease. Results: After confounding factors, significantly predicted CoP ML-Amplitude (β 0.638, p 0.004) ML-Velocity 0.653, 0.002) eyes-opened condition. Conclusions: present study detected negative association between control ML direction, suggesting that caution should be taken when prescribing adults, could decrease stability ultimately increase fall fracture risks.

Язык: Английский

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Anticholinergic burden measures, symptoms, and fall-associated risk in older adults with polypharmacy: Development and validation of a prognostic model

PLoS ONE, Год журнала: 2023, Номер 18(1), С. e0280907 - e0280907

Опубликована: Янв. 23, 2023

Anticholinergic burden has been associated with adverse outcomes such as falls. To date, no gold standard measure identified to assess anticholinergic burden, and conclusion drawn on which of the different algorithms best predicts falls in older patients from general practice. This study compared ability five measures predict account for patients' individual susceptibility medications, added predictive value typical symptoms was further quantified this context.

Язык: Английский

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Exposure to anticholinergic and sedative medication is associated with impaired functioning in older people with vertigo, dizziness and balance disorders—Results from the longitudinal multicenter study MobilE-TRA

Frontiers in Pharmacology, Год журнала: 2023, Номер 14

Опубликована: Март 3, 2023

Introduction: Anticholinergic and sedative medication is prescribed for various conditions in older patients. While the general association between anticholinergic impaired functioning well established, its specific role individuals with vertigo, dizziness, balance disorders (VDB) still incompletely understood. The objective of this study was to investigate, whether an exposure associated lower generic vertigo-specific patients VDB. Methods: Data originates from longitudinal multicenter MobilE-TRA two follow-ups, conducted 2017 2019 German federal states. Exposure quantified using drug burden index (DBI). Generic assessed by Health Assessment Questionnaire Disability Index, appraising amount difficulties performing activities daily living (ADL). Vertigo-specific measured Vestibular Activities Participation (VAP) questionnaire, assessing patient-reported regarding that are difficult perform because their propensity provoke VDB (Scale 1) as immediate consequences on participation related mobility 2). Longitudinal linear mixed models were applied assess at baseline level status over time. Results: An overall 19 (7 Bavaria) primary care physicians (mean age = 54 years, 29% female) recruited 158 (59% (median 78 70% female). present 56 (35%) significantly [Beta 0.40, 95%-CI (0.18; 0.61)] [VAP Scale 1: Beta 2.47, (0.92; 4.02)], VAP 2: 3.74, [2.23; 5.24]). Conclusion: Our results highlight importance a close monitoring use When feasible, should be replaced equivalent alternative therapies order potentially reduce

Язык: Английский

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Anticholinergic Burden and Xerostomia in Critical Care Settings

Dimensions of Critical Care Nursing, Год журнала: 2023, Номер 42(6), С. 310 - 318

Опубликована: Сен. 27, 2023

Although previous studies have established the association of medications with anticholinergic adverse effects and xerostomia, burden xerostomia in critical care settings are poorly characterized. The objective this study was to determine impact medication burdens associated effects, particularly occurrence (dry mouth) a setting. In addition, explored correlation between timing first instance administration known effects.A retrospective case-control used MIMIC (Medical Information Mart for Intensive Care) III database. MIMIC-III clinical database is publicly available, deidentified, health-related more than 40 000 patients units from 2001 2012. Cases (n = 1344) were selected notes reporting "dry mouth," "xerostomia," or evidence pharmacological treatment xerostomia; control 4032) using propensity analysis 1:3 matching on covariates (eg, age, sex, race, ethnicity, length stay). quantified as cumulative effect activities Anticholinergic Burden Scale.Anticholinergic significantly differed subjects (P .04). stay statistically significant factor xerostomia. probability developing symptom within 24 hours .95 (95%) xerostomia.Anticholinergic Scale setting, after admission. It crucial carefully evaluate alternative options that may potential effects. This evaluation should include assessing balance benefits harms, considering withdrawal reactions, prioritizing deprescribing whenever feasible initial 24-hour period.

Язык: Английский

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A five-year prospective evaluation of anticholinergic cognitive burden and falls in the Malaysian elders longitudinal research (MELoR) study

Archives of Gerontology and Geriatrics, Год журнала: 2021, Номер 98, С. 104535 - 104535

Опубликована: Сен. 30, 2021

Язык: Английский

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Chronic isolated lightheadedness is a sign of abnormal plasma levels of phospholipids

Experimental Gerontology, Год журнала: 2021, Номер 146, С. 111249 - 111249

Опубликована: Янв. 22, 2021

Язык: Английский

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