Quantification of anticholinergic and sedative drug load with the Drug Burden Index: a review of outcomes and methodological quality of studies

Abstract

PurposeThe 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.MethodsA 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. Methodological quality was assessed using the Newcastle-Ottawa Scale. Potential omissions of relevant clinical outcomes and populations were studied.ResultsOf the 2998 identified publications, 21 were eligible. Overall, methodological quality of studies was good. In all but one study, adjustment was made for prevalent co-morbidity. The DBI was examined in diverse older individuals, i.e. both males and females from different settings and countries. However, no studies were conducted in other relevant patient groups, e.g. psychiatric patients. Exposure to anticholinergic and sedative drugs was thoroughly ascertained, though the specific calculation of the DBI differed across studies. Outcomes were assessed from medical records, record linkage or validated objective tests or questionnaires. Many studies found associations between the DBI and outcomes including hospitalisation, physical and cognitive function. Cognitive function and quality of life were understudied and the number and scope of longitudinal studies was limited.ConclusionsAn accumulating body of evidence supports the validity of the DBI. Longitudinal studies of cognitive function and quality of life and in other patient groups, e.g. psychiatric patients, are warranted.Electronic supplementary materialThe online version of this article (doi:10.1007/s00228-016-2162-6) contains supplementary material, which is available to authorized users.

Anticholinergic exposure and cognitive decline in older adults: effect of anticholinergic exposure definitions in a 3‐year analysis of the multidomain Alzheimer preventive trial (MAPT) study

“…However, a proxy confirmation could have been sought in the presence of unreliable self‐reports. In addition, we were not able to take into account the duration of exposure and dose of anticholinergic drug used, and therefore could not use other measures such as the Drug Burden Index scale . A recent study that was able to take into account duration and dose found a significant association with the incidence of dementia for a follow‐up period of ≥4 years.…”

Anticholinergic and sedative medication use in older community‐dwelling people: A national population study in the Netherlands

“…Anticholinergic/sedative medication load was quantified with the drug burden index (DBI) . Previous studies have identified that a higher DBI was associated with an increased risk of medication harm among older populations . The DBI was calculated using the following formula: where D = prescribed daily dose and δ = the minimum recommended daily dose according to Dutch pharmacotherapeutic reference sources…”

“…11 Previous studies have identified that a higher DBI was associated with an increased risk of medication harm among older populations. 12 The DBI was calculated using the following formula:…”

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

“…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].…”