1. ¹Division of Clinical Pharmacology, Johns Hopkins School of Medicine, Baltimore, MD
2. ²University of Buffalo School of Pharmacy, Buffalo, New York
3. ³Institute on Aging Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD
4. ⁴Geriatric Medicine, Johns Hopkins University, Baltimore, MD

Abstract

Background/aims: Expert consensus-derived lists or numbers of drugs prescribed are two current approaches to evaluate appropriateness of drug therapy for older patients. We hypothesized that drugs with anticholinergic and/or sedative properties contribute to drug exposure related morbidity, and that development of a drug burden index to characterize extent of exposure to these drugs would have utility to predict drug-induced disability independent of disease and other potential confounders.

Methods:

Design: Cross-sectional study. Multivariate logistic regression.

Setting: Home visits and medical records.

Participants: Women aged 65+ years from the Women's Health and Aging Study (WHAS I) in Baltimore, Maryland.

Results: Drug burden based on pharmacodynamic principles was defined. A strong independent relation between anticholinergic burden and greater activities of daily living difficulty, poorer balance, chair stands, mobility, gait speed, MMSE performance, difficulty of upper extremity function, and weaker grip strength was demonstrated. Sedative burden was only associated with impaired grip strength and mobility.

Conclusions: (1) Burden of multiple drugs can be quantified with the recommended dose regimen and the actual dose and frequency of drug taken. (2) Anticholinergic burden is strongly associated with impaired performance of a variety of functions important to independent living. Sedative burden results in impairment of a more limited array of functions.