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Observational Study
. 2024 Dec;43(4):706-714.
doi: 10.1111/ajag.13333. Epub 2024 May 21.

A comparison of changes in drug burden index between older inpatients who fell and people who have not fallen: A case-control study

Claire E T O'Leary  1 , Timothy J Wilkinson  1   2 , H Carl Hanger  1   2
Affiliations
Observational Study

A comparison of changes in drug burden index between older inpatients who fell and people who have not fallen: A case-control study

Claire E T O'Leary et al. Australas J Ageing. 2024 Dec.

Abstract

Objective: Older inpatients who fall are often frail, with multiple co-morbidities and polypharmacy. Although the causes of falls are multifactorial, sedating and delirium-inducing drugs increase that risk. The aims were to determine whether people who fell had a change in their sedative and anticholinergic medication burden during an admission compared to people who did not fall. A secondary aim was to determine the factors associated with change in drug burden.

Methods: A retrospective, observational, case-control study of inpatients who fell. Two hundred consecutive people who fell were compared with 200 randomly selected people who had not fallen. Demographics, functional ability, frailty and cognition were recorded. For each patient, their total medications and anticholinergic and sedative burden were calculated on admission and on discharge, using the drug burden index (DBI).

Results: People who fell were more dependent and cognitively impaired than people who did not fallen. People who fell had a higher DBI on admission, than people who had not fall (mean: .69 vs .43, respectively, p < .001) and discharge (.66 vs .38, p < .001). For both cohorts, the DBI decreased between admission and discharge (-.03 and -.05), but neither were clinically significant. Higher total medications and a higher number DBI medications on admission were both associated with greater DBI changes (p = .003 and <.001, respectively). However, the presence (or absence) of cognitive impairment, dependency, frailty and single vs multiple falls were not significantly associated with DBI changes.

Conclusions: In older people, DBI medications and falls are both common and have serious consequences, yet this study was unable to demonstrate any clinically relevant reduction in average DBI either in people who fell or people who had not fallen during a hospital admission.

Keywords: aged; anticholinergics; sedatives.

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Conflict of interest statement

Dr Timothy J Wilkinson is an Editorial Board Member of the Australasian Journal on Ageing. The other authors declare that they have no conflicts of interests.

Figures

FIGURE 1
FIGURE 1
CONSORT flow diagram.
FIGURE 2
FIGURE 2
Change in drug burden index (DBI) for the admission (mean with 95% CI) for people who fell and people who have not fallen.
FIGURE 3
FIGURE 3
Change in drug burden index (DBI) during admission and cognitive impairment (mean and 95% CI).
See this image and copyright information in PMC

References

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