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Is the Drug Burden Index Related to Declining Functional Status at Follow-up in Community-Dwelling Seniors Consulting for Minor Injuries? Results from the Canadian Emergency Team Initiative Cohort Study

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Abstract

Background

The Canadian Emergency Team Initiative (CETI) cohort showed that minor injuries like sprained ankles or small fractures trigger a downward spiral of functional decline in 16% of independent seniors up to 6 months post-injury. Such seniors frequently receive medications with sedative or anticholinergic properties. The Drug Burden Index (DBI), which summarises the drug burden of these specific medications, has been associated with decreased physical and cognitive functioning in previous research.

Objectives

We aimed to assess the contribution of the DBI to functional decline in the CETI cohort.

Methods

CETI participants were assessed physically and cognitively at baseline during their consultations at emergency departments (EDs) for their injuries and up to 6 months thereafter. The medication data were used to calculate baseline DBI and functional status was measured with the Older Americans Resources and Services (OARS) scale. Multivariate linear regression models assessed the association between baseline DBI and functional status at 6 months, adjusting for age, sex, baseline OARS, frailty level, comorbidity count, and mild cognitive impairment.

Results

The mean age of the 846 participants was 77 years and their mean DBI at baseline was 0.24. Complete follow-up data at 3 or 6 months was available for 718 participants among whom a higher DBI at the time of injury contributed to a lower functional status at 6 months. Each additional point in the DBI lead to a loss of 0.5 points on the OARS functional scale, p < 0.001. Among those with a DBI ≥ 1, 27.4% were considered ‘patients who decline’ at 3 or 6 months’ follow-up, compared with 16.0% of those with a DBI of 0 (p = 0.06).

Conclusions

ED visits are considered missed opportunities for optimal care interventions in seniors; Identifying their DBI and adjusting treatment accordingly may help limit functional decline in those at risk after minor injury.

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Authors and Affiliations

  1. Faculté de pharmacie, Université Laval, Québec, Canada

    Edeltraut Kröger

  2. Centre d’excellence sur le vieillissement de Québec du Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSSCN), Québec, Canada

    Edeltraut Kröger, Marilyn Simard, Marie-Josée Sirois, Marianne Giroux, Caroline Sirois, Pierre-Hugues Carmichael & Marcel Émond

  3. Faculté de médecine, Université Laval, Québec, Canada

    Marilyn Simard, Marie-Josée Sirois, Caroline Sirois & Marcel Émond

  4. Axe santé des populations et pratiques optimales en santé, Centre de recherche du Centre Hospitalier Universitaire (CHU) de Québec, Québec, Canada

    Edeltraut Kröger, Marie-Josée Sirois, Marianne Giroux, Caroline Sirois, Pierre-Hugues Carmichael & Marcel Émond

  5. NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia

    Lisa Kouladjian-O’Donnell, Emily Reeve & Sarah Hilmer

  6. Kolling Institute of Medical Research, University of Sydney and Royal North Shore Hospital, St Leonards, NSW, Australia

    Lisa Kouladjian-O’Donnell, Emily Reeve & Sarah Hilmer

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  1. Edeltraut Kröger
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Correspondence to Edeltraut Kröger.

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Funding

This study received financial and logistic support from the Réseau québécois de recherche sur le vieillissement du Fonds de recherche québecois—santé (MJS and study team) and the Quebec Centre for Excellence in Aging of the Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSSCN) (EK, MJS and study team) and from the Centre de recherche du CHU de Québec. None of the financial contributors participated in collection, analysis, or interpretation of data, or in writing the manuscript.

Conflict of interest

Edeltraut Kröger, Marilyn Simard, Marie-Josée Sirois, Marianne Giroux, Caroline Sirois, Lisa Kouladjian-O’Donnell, Emily Reeve, Sarah Hilmer, Pierre-Hugues Carmichael and Marcel Émond declare that they have no conflict of interest relevant to the content of this publication.

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Kröger, E., Simard, M., Sirois, MJ. et al. Is the Drug Burden Index Related to Declining Functional Status at Follow-up in Community-Dwelling Seniors Consulting for Minor Injuries? Results from the Canadian Emergency Team Initiative Cohort Study. Drugs Aging 36, 73–83 (2019). https://doi.org/10.1007/s40266-018-0604-9

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