Shahar Shmuel1, Virginia Pate1, Marc J Pepin2, Janine C Bailey2, Laura C Hanson3,4, Til Stürmer1, Rebecca B Naumann1,5, Yvonne M Golightly1,5,6,7, Danijela Gnjidic8,9, Jennifer L Lund1. 1. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 2. Durham VA Geriatric Research Education and Clinical Center (GRECC), Durham, North Carolina, USA. 3. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 4. Division of Geriatric Medicine and Palliative Care Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 5. Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 6. Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 7. Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 8. Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia. 9. Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia.
Abstract
PURPOSE: Medications with anticholinergic and sedative properties are widely used among older adults despite strong evidence of harm. The drug burden index (DBI), a pharmacological screening tool, measures these properties across drug classes, and higher DBI drug exposure (DBI > 1) has been associated with certain physical function-related adverse events. Our aim was to quantify mean daily DBI drug exposure among older adults in the United States (US). METHODS: We screened medications for DBI properties and operationalized the DBI for US Medicare claims. We then conducted a retrospective cohort study of a 20% random, nationwide sample of 4 137 384 fee-for-service Medicare beneficiaries aged 66+ years (134 757 039 person-months) from January 2013 to December 2016. We measured the monthly distribution based on mean daily DBI, categorized as (a) >0 vs 0 (any use) and (b) 0, 0 < DBI ≤ 1, 1 < DBI ≤ 2, and DBI > 2, and examined temporal trends. We described patient-level factors (eg, demographics, healthcare use) associated with high (>2) vs low (0 < DBI≤1) DBI drug exposure. RESULTS: The distribution of the mean daily DBI, aggregated at the month-level, was: 58.1% DBI = 0, 29.0% 0 < DBI≤1, 9.3% 1 < DBI≤2, and 3.7% DBI > 2. Predictors of high monthly DBI drug exposure (DBI > 2) included certain indicators of increased healthcare use (eg, high number of drug claims), white race, younger age, frailty, and a psychosis diagnosis code. CONCLUSIONS: The predictors of high DBI drug exposure can inform discussions between patients and providers about medication appropriateness and potential de-prescribing. Future Medicare-based studies should assess the association between the DBI and adverse events.
PURPOSE: Medications with anticholinergic and sedative properties are widely used among older adults despite strong evidence of harm. The drug burden index (DBI), a pharmacological screening tool, measures these properties across drug classes, and higher DBI drug exposure (DBI > 1) has been associated with certain physical function-related adverse events. Our aim was to quantify mean daily DBI drug exposure among older adults in the United States (US). METHODS: We screened medications for DBI properties and operationalized the DBI for US Medicare claims. We then conducted a retrospective cohort study of a 20% random, nationwide sample of 4 137 384 fee-for-service Medicare beneficiaries aged 66+ years (134 757 039 person-months) from January 2013 to December 2016. We measured the monthly distribution based on mean daily DBI, categorized as (a) >0 vs 0 (any use) and (b) 0, 0 < DBI ≤ 1, 1 < DBI ≤ 2, and DBI > 2, and examined temporal trends. We described patient-level factors (eg, demographics, healthcare use) associated with high (>2) vs low (0 < DBI≤1) DBI drug exposure. RESULTS: The distribution of the mean daily DBI, aggregated at the month-level, was: 58.1% DBI = 0, 29.0% 0 < DBI≤1, 9.3% 1 < DBI≤2, and 3.7% DBI > 2. Predictors of high monthly DBI drug exposure (DBI > 2) included certain indicators of increased healthcare use (eg, high number of drug claims), white race, younger age, frailty, and a psychosis diagnosis code. CONCLUSIONS: The predictors of high DBI drug exposure can inform discussions between patients and providers about medication appropriateness and potential de-prescribing. Future Medicare-based studies should assess the association between the DBI and adverse events.
Keywords:
aging; cholinergic antagonists; drug burden index; drug utilization; hypnotics and sedatives; inappropriate prescribing; pharmacoepidemiology
Authors: Donovan T Maust; Frederic C Blow; Ilse R Wiechers; Helen C Kales; Steven C Marcus Journal: J Clin Psychiatry Date: 2017-04 Impact factor: 4.384
Authors: Jenny W Sun; James R Rogers; Qoua Her; Emily C Welch; Catherine A Panozzo; Sengwee Toh; Joshua J Gagne Journal: Med Care Date: 2017-12 Impact factor: 2.983
Authors: Hamish A Jamieson; Prasad S Nishtala; Richard Scrase; Joanne M Deely; Rebecca Abey-Nesbit; Martin J Connolly; Sarah N Hilmer; Darrell R Abernethy; Philip J Schluter Journal: Drugs Aging Date: 2018-01 Impact factor: 3.923
Authors: Tanja Mayer; Andreas Daniel Meid; Kai-Uwe Saum; Hermann Brenner; Ben Schöttker; Hanna Marita Seidling; Walter Emil Haefeli Journal: Am J Geriatr Psychiatry Date: 2017-01-23 Impact factor: 4.105
Authors: Danijela Gnjidic; Sarah N Hilmer; Sirpa Hartikainen; Anna-Maija Tolppanen; Heidi Taipale; Marjaana Koponen; J Simon Bell Journal: PLoS One Date: 2014-01-13 Impact factor: 3.240
Authors: Lisa Kouladjian; Danijela Gnjidic; Timothy F Chen; Arduino A Mangoni; Sarah N Hilmer Journal: Clin Interv Aging Date: 2014-09-09 Impact factor: 4.458
Authors: Shahar Shmuel; Virginia Pate; Marc J Pepin; Janine C Bailey; Yvonne M Golightly; Laura C Hanson; Til Stürmer; Rebecca B Naumann; Danijela Gnjidic; Jennifer L Lund Journal: J Am Geriatr Soc Date: 2021-07-22 Impact factor: 5.562