A measure of an individual’s total exposure to anticholinergic and sedative medications, a higher Drug Burden Index (DBI) is associated with an increased risk of falls and decreased function and cognition, according to the authors of a systematic review. “Higher DBI was inconsistently associated with increased mortality, length of stay, frailty, hospitalization or reduced quality of life,” the report states. “Human observational findings with respect to functional outcomes are supported by preclinical interventional studies. The DBI may be used as a tool to identify older adults at higher risk of harm.”
A systematic review was conducted for the 2007–2022 time period to identify studies that reported primary data on the association of the DBI with clinical or prescribing outcomes in adults and animals. Because of the heterogeneity of the data, meta-analysis was not appropriate.
“Of 2,382 studies screened, 70 met the inclusion criteria (65 in humans, five in animals [mice]),” the authors write. “In humans, outcomes reported included function (n = 56), cognition (n = 20), falls (n = 14), frailty (n = 7), mortality (n = 9), quality of life (n = 8), hospitalization (n = 7), length of stay (n = 5), readmission (n = 1), other clinical outcomes (n = 15) and prescribing outcomes (n = 2). A higher DBI was significantly associated with increased falls (11/14, 71%), poorer function (31/56, 55%), and cognition (11/20, 55%) related outcomes.… In animals, outcomes reported included function (n = 18), frailty (n = 2), and mortality (n = 1). In pre-clinical studies, a higher DBI caused poorer function and frailty.”