Associations between the Drug Burden Index, Potentially Inappropriate Medications and Quality of Life in Residential Aged Care
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Inappropriate polypharmacy may negatively impact the quality of life of residents in aged care facilities, but it remains unclear which medications may influence this reduced quality of life.
The objective of this study was to examine whether the Drug Burden Index and potentially inappropriate medications were associated with quality of life in older adults living in residential care with a high prevalence of cognitive impairment and dementia.
We conducted cross-sectional analyses of 541 individuals recruited from 17 residential aged care facilities in Australia in the Investigating Services Provided in the Residential Environment for Dementia (INSPIRED) study. Quality of life was measured using the EuroQol Five Dimensions Questionnaire (a measure of generic quality of life) and the Dementia Quality of Life Questionnaire completed by the participant or a proxy.
In the 100 days prior to recruitment, 83.1% of the participants received at least one anticholinergic or sedative medication included in the Drug Burden Index and 73.0% received at least one potentially inappropriate medication according to the Beers Criteria. Multi-level linear models showed there was a significant association between a higher Drug Burden Index and lower quality of life according to the EuroQol Five Dimensions Questionnaire [β (standard error): − 0.034 (0.012), p = 0.006] after adjustment for potential confounding factors. Increasing numbers of potentially inappropriate medications were also associated with lower EuroQol Five Dimensions Questionnaire scores [− 0.030 (0.010), p = 0.003] and Dementia Quality of Life Questionnaire-Self-Report-Utility scores [− 0.020 (0.009), p = 0.029]. Exposure to both Drug Burden Index-associated medications and potentially inappropriate medications was associated with lower Dementia Quality of Life Questionnaire-Self-Report-Utility scores [− 0.034 (0.017), p = 0.049].
Exposure to anticholinergic and sedative medications and potentially inappropriate medications occurred in over three-quarters of a population of older adults in residential care and was associated with a lower quality of life.
The authors sincerely thank the INSPIRED study participants and their family members for their participation and interest in the study. The assistance of facility staff, care worker researchers, facility pharmacists and data collectors in each state is gratefully acknowledged. We thank members of the study team Mrs Anne Whitehouse, Mrs Angela Basso, Ms Keren McKenna, Dr. Wendy Shulver and Dr. Rebecca Bilton for their input into the INSPIRED study management, data collection and data coordination.
This study and the researchers are supported by funding provided by the National Health and Medical Research Council Cognitive Decline Partnership Centre (Grant no. GNT9100000). This Partnership Centre includes Australian aged care residential service providers: HammondCare, Helping Hand Aged Care and Brightwater Care Group. Although these industry partners did not provide funding for this study they did provide advice and access to their facilities. The contents of the published materials are solely the responsibility of the administering institution, Flinders University and the individual authors identified, and do not reflect the views of the National Health and Medical Research Council or any other funding bodies or the funding partners. No sources of funding other than that described above (Grant no. GNT9100000) were used to assist in the conduct of this study or preparation of this article.
Compliance with Ethical Standards
Conflict of interest
Suzanne Dyer was employed in the development of the Clinical Practice Guidelines for Dementia in Australia, which includes recommendations relating to the use of pharmaceuticals in dementia. Stephanie Harrison, Lisa Kouladjian O’Donnell, Clare Bradley, Rachel Milte, Emmanuel Gnanamanickam, Enwu Liu, Sarah Hilmer and Maria Crotty have no conflicts of interest directly relevant to the content of this article.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional committee (Flinders Social and Behavioural Research Ethics Committee: Approval Nos. 6732 and 6753). Informed consent was obtained from all individual participants included in the study (self-consent or proxy) as approved by the ethics committee.
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