Edeltraut Kröger1,2,3, Marilyn Simard4,5, Marie-Josée Sirois4,5,6, Marianne Giroux4,6, Caroline Sirois4,5,6, Lisa Kouladjian-O'Donnell7,8, Emily Reeve7,8, Sarah Hilmer7,8, Pierre-Hugues Carmichael4,6, Marcel Émond4,5,6. 1. Faculté de pharmacie, Université Laval, Québec, Canada. edeltraut.kroger.ciussscn@ssss.gouv.qc.ca. 2. Centre d'excellence sur le vieillissement de Québec du Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSSCN), Québec, Canada. edeltraut.kroger.ciussscn@ssss.gouv.qc.ca. 3. Axe santé des populations et pratiques optimales en santé, Centre de recherche du Centre Hospitalier Universitaire (CHU) de Québec, Québec, Canada. edeltraut.kroger.ciussscn@ssss.gouv.qc.ca. 4. Centre d'excellence sur le vieillissement de Québec du Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSSCN), Québec, Canada. 5. Faculté de médecine, Université Laval, Québec, Canada. 6. Axe santé des populations et pratiques optimales en santé, Centre de recherche du Centre Hospitalier Universitaire (CHU) de Québec, Québec, Canada. 7. NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia. 8. Kolling Institute of Medical Research, University of Sydney and Royal North Shore Hospital, St Leonards, NSW, Australia.
Abstract
BACKGROUND: The Canadian Emergency Team Initiative (CETI) cohort showed that minor injuries like sprained ankles or small fractures trigger a downward spiral of functional decline in 16% of independent seniors up to 6 months post-injury. Such seniors frequently receive medications with sedative or anticholinergic properties. The Drug Burden Index (DBI), which summarises the drug burden of these specific medications, has been associated with decreased physical and cognitive functioning in previous research. OBJECTIVES: We aimed to assess the contribution of the DBI to functional decline in the CETI cohort. METHODS: CETI participants were assessed physically and cognitively at baseline during their consultations at emergency departments (EDs) for their injuries and up to 6 months thereafter. The medication data were used to calculate baseline DBI and functional status was measured with the Older Americans Resources and Services (OARS) scale. Multivariate linear regression models assessed the association between baseline DBI and functional status at 6 months, adjusting for age, sex, baseline OARS, frailty level, comorbidity count, and mild cognitive impairment. RESULTS: The mean age of the 846 participants was 77 years and their mean DBI at baseline was 0.24. Complete follow-up data at 3 or 6 months was available for 718 participants among whom a higher DBI at the time of injury contributed to a lower functional status at 6 months. Each additional point in the DBI lead to a loss of 0.5 points on the OARS functional scale, p < 0.001. Among those with a DBI ≥ 1, 27.4% were considered 'patients who decline' at 3 or 6 months' follow-up, compared with 16.0% of those with a DBI of 0 (p = 0.06). CONCLUSIONS: ED visits are considered missed opportunities for optimal care interventions in seniors; Identifying their DBI and adjusting treatment accordingly may help limit functional decline in those at risk after minor injury.
BACKGROUND: The Canadian Emergency Team Initiative (CETI) cohort showed that minor injuries like sprained ankles or small fractures trigger a downward spiral of functional decline in 16% of independent seniors up to 6 months post-injury. Such seniors frequently receive medications with sedative or anticholinergic properties. The Drug Burden Index (DBI), which summarises the drug burden of these specific medications, has been associated with decreased physical and cognitive functioning in previous research. OBJECTIVES: We aimed to assess the contribution of the DBI to functional decline in the CETI cohort. METHODS: CETI participants were assessed physically and cognitively at baseline during their consultations at emergency departments (EDs) for their injuries and up to 6 months thereafter. The medication data were used to calculate baseline DBI and functional status was measured with the Older Americans Resources and Services (OARS) scale. Multivariate linear regression models assessed the association between baseline DBI and functional status at 6 months, adjusting for age, sex, baseline OARS, frailty level, comorbidity count, and mild cognitive impairment. RESULTS: The mean age of the 846 participants was 77 years and their mean DBI at baseline was 0.24. Complete follow-up data at 3 or 6 months was available for 718 participants among whom a higher DBI at the time of injury contributed to a lower functional status at 6 months. Each additional point in the DBI lead to a loss of 0.5 points on the OARS functional scale, p < 0.001. Among those with a DBI ≥ 1, 27.4% were considered 'patients who decline' at 3 or 6 months' follow-up, compared with 16.0% of those with a DBI of 0 (p = 0.06). CONCLUSIONS: ED visits are considered missed opportunities for optimal care interventions in seniors; Identifying their DBI and adjusting treatment accordingly may help limit functional decline in those at risk after minor injury.
Authors: Sarah N Hilmer; Donald E Mager; Eleanor M Simonsick; Shari M Ling; B Gwen Windham; Tamara B Harris; Ronald I Shorr; Douglas C Bauer; Darrell R Abernethy Journal: Am J Med Date: 2009-12 Impact factor: 4.965
Authors: Mandavi Kashyap; Sylvie Belleville; Benoit H Mulsant; Sarah N Hilmer; Amelie Paquette; Le Mai Tu; Cara Tannenbaum Journal: J Am Geriatr Soc Date: 2014-01-13 Impact factor: 5.562