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Associations between Drug Burden Index and Mortality in Older People in Residential Aged Care Facilities

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Abstract

Background: The Drug Burden Index (DBI), a measure of an individual’s exposure to anticholinergic and sedative medications, is associated with functional impairment in community-dwelling, older people. In people from residential aged care facilities (RACFs), DBI score does not appear to be associated with functional impairment, but is associated with an increased risk of falls.

Objective: We investigated the associations between increasing DBI score and mortality in older adults living in RACFs.

Methods: Study participants (n= 602; 70.9% female), recruited from 51 RACFs in Sydney, Australia, had a mean ± standard deviation (SD) age of 85.7 ±6.4 years and a mean ± SD DBI score of 0.58 ± 0.64.

Results: Exposure to anticholinergic medication was 33.6% and sedative medications 41.9%. All-cause mortality after a variable follow-up time (774–1269 days) was 36.2% (n = 218), with the leading causes of death classified as stroke (n = 46; 21.1%), ischaemic heart disease/cardiovascular system (n = 44; 20.2%) and pneumonia (n = 31; 14.2%). One-year mortality multivariate models showed that the DBI categories low (n = 260; hazard ratio [HR] 1.13; 95% CI 0.82, 1.57) and high (n= 153; HR 1.19; 95% CI 0.82, 1.74) were not associated with mortality. This lack of a significant association remained after dichotomization into the anticholinergic and sedative components of the DBI.

Conclusions: We found that with high exposure to anticholinergic and sedative medications, there was no significant association between increasing DBI score and all-cause mortality in old individuals living in RACFs. Further research into the adverse effects of medication use on the mortality of institutionalized older individuals is needed.

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Acknowledgements

This work was supported by a National Health and Medical Research Council project (grant number 402639). S. Hilmer holds an international patent for the Drug Burden Index with D.R. Abernethy and D. Major. The other authors have no conflicts of interest that are directly relevant to the content of this study.

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Authors and Affiliations

  1. Kolling Institute of Medical Research, Institute of Bone and Joint Research, Royal North Shore Hospital, Sydney, NSW, 2065, Australia

    Nicholas M. Wilson, Lyn M. March, Jian Sheng Chen & Philip N. Sambrook

  2. Sydney Medical School, University of Sydney, Sydney, NSW, Australia

    Nicholas M. Wilson, Sarah N. Hilmer, Lyn M. March, Danijela Gnjidic, Rebecca S. Mason, Ian D. Cameron & Philip N. Sambrook

  3. Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, Sydney, NSW, Australia

    Sarah N. Hilmer & Danijela Gnjidic

  4. School of Public Health, University of Sydney, Sydney, NSW, Australia

    Jian Sheng Chen

  5. Department of Physiology, University of Sydney, Sydney, NSW, Australia

    Rebecca S. Mason

  6. Bosch Institute, University of Sydney, Sydney, NSW, Australia

    Rebecca S. Mason

  7. Rehabilitation Studies Unit, University of Sydney, Ryde, NSW, Australia

    Ian D. Cameron

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  1. Nicholas M. Wilson
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Correspondence to Nicholas M. Wilson.

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Wilson, N.M., Hilmer, S.N., March, L.M. et al. Associations between Drug Burden Index and Mortality in Older People in Residential Aged Care Facilities. Drugs Aging 29, 157–165 (2012). https://doi.org/10.2165/11598570-000000000-00000

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