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A Drug Burden Index to Define the Functional Burden of Medications in Older People
Sarah N. Hilmer, MD, PhD;
Donald E. Mager, PharmD, PhD;
Eleanor M. Simonsick, PhD;
Ying Cao, MB;
Shari M. Ling, MD;
B. Gwen Windham, MD;
Tamara B. Harris, MD, MS;
Joseph T. Hanlon, PharmD, MS;
Susan M. Rubin, MPH;
Ronald I. Shorr, MD, MS;
Douglas C. Bauer, MD, MPH;
Darrell R. Abernethy, MD, PhD
Arch Intern Med. 2007;167(8):781-787.
Background Older people carry a high burden of illness for which medications are indicated, along with increased risk of adverse drug reactions. We developed an index to determine drug burden based on pharmacologic principles. We evaluated the relationship of this index to physical and cognitive performance apart from disease indication.
Methods Data from the Health, Aging, and Body Composition Study on 3075 well-functioning community-dwelling persons aged 70 to 79 years were analyzed by multiple linear regression to assess the cross-sectional association of drug burden index with a validated composite continuous measure for physical function, and with the Digit Symbol Substitution Test for cognitive performance.
Results Use of anticholinergic and sedative medications was associated with poorer physical performance score (anticholinergic exposure, 2.08 vs 2.21, P<.001; sedative exposure, 2.09 vs 2.19, P<.001) and cognitive performance on the Digit Symbol Substitution Test (anticholinergic exposure, 34.5 vs 35.5, P = .045; sedative exposure, 34.0 vs 35.5, P = .01). Associations were strengthened when exposure was calculated by principles of dose response. An increase of 1 U in drug burden index was associated with a deficit of 0.15 point (P<.001) on the physical function scale and 1.5 points (P = .01) on the Digit Symbol Substitution Test. These values were more than 3 times those associated with a single comorbid illness.
Conclusions The drug burden index demonstrates that anticholinergic and sedative drug exposure is associated with poorer function in community-dwelling older people. This pharmacologic approach provides a useful evidence-based tool for assessing the functional effect of exposure to medications in this population.
Author Affiliations: Laboratory of Clinical Investigation and Clinical Research Branch, Intramural Research Program, National Institute on Aging, Baltimore and Bethesda, Md (Drs Hilmer, Mager, Simonsick, Ling, Windham, Harris, and Abernethy); Division of Clinical Pharmacology, The Johns Hopkins University, Baltimore (Dr Cao); Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, Pa (Dr Hanlon); Prevention Sciences Group and Department of Medicine, University of California, San Francisco (Ms Rubin and Dr Bauer); and Department of Preventive Medicine, University of Tennessee at Memphis (Dr Shorr). Dr Hilmer is now with the Department of Medicine, University of Sydney, Sydney, Australia; Dr Mager is now with the Department of Pharmaceutical Sciences, University at Buffalo, State University of New York.
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