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. 2009 Dec;122(12):1142-1149.e1-2.
doi: 10.1016/j.amjmed.2009.02.021.

Drug burden index score and functional decline in older people

Sarah N Hilmer  1 , Donald E Mager, Eleanor M Simonsick, Shari M Ling, B Gwen Windham, Tamara B Harris, Ronald I Shorr, Douglas C Bauer, Darrell R Abernethy; Health ABC Study
Affiliations

Drug burden index score and functional decline in older people

Sarah N Hilmer et al. Am J Med. 2009 Dec.

Abstract

Background: The Drug Burden Index (DBI), a measure of exposure to anticholinergic and sedative medications, has been independently associated with physical and cognitive function in a cross-sectional analysis of community-dwelling older persons participating in the Health, Aging and Body Composition study. Here we evaluate the association between DBI and functional outcomes in Health, Aging and Body Composition study participants over 5 years.

Methods: DBI was calculated at years 1 (baseline), 3, and 5, and a measure of the area under the curve for DBI (AUCDB) over the whole study period was devised and calculated. Physical performance was measured using the short physical performance battery, usual gait speed, and grip strength. The association of DBI at each time point and AUCDB with year 6 function was analyzed in data from participants with longitudinal functional measures, controlling for sociodemographics, comorbidities, and baseline function.

Results: Higher DBI at years 1, 3, and 5 was consistently associated with poorer function at year 6. On multivariate analysis, a 1-unit increase in AUCDB predicted decreases in short physical performance battery score of .08 (P=.01), gait speed of .01 m/s (P=.004), and grip strength of .27 kg (P=.004) at year 6.

Conclusion: Increasing exposure to medication with anticholinergic and sedative effects, measured with DBI, is associated with lower objective physical function over 5 years in community-dwelling older people.

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Figures

Figure 1
Figure 1
Association between higher Drug Burden Index (DBI) at years 1, 3 and 5, and total drug burden exposure over five years, calculated using area under the drug burden time curve (AUCDB), with lower functional scores at year 6 measured with SPPB score (A), usual gait speed in m/s (B) or grip strength in kg (C). DBI and AUCDB grouped into 0, 0-1 and ≥ 1. Means adjusted for year 1 functional score, co-morbidities, hospitalizations and sociodemographic factors using analysis of co-variance. Error bars show 95% confidence intervals. * indicates that the difference between bars linked by brackets is statistically significant, p<0.05. Number of subjects at each level of exposure at each time point is shown in table below each figure.
Figure 1
Figure 1
Association between higher Drug Burden Index (DBI) at years 1, 3 and 5, and total drug burden exposure over five years, calculated using area under the drug burden time curve (AUCDB), with lower functional scores at year 6 measured with SPPB score (A), usual gait speed in m/s (B) or grip strength in kg (C). DBI and AUCDB grouped into 0, 0-1 and ≥ 1. Means adjusted for year 1 functional score, co-morbidities, hospitalizations and sociodemographic factors using analysis of co-variance. Error bars show 95% confidence intervals. * indicates that the difference between bars linked by brackets is statistically significant, p<0.05. Number of subjects at each level of exposure at each time point is shown in table below each figure.
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