Drug Burden Index and Potentially Inappropriate Medications in Community-dwelling Older People: the Impact of Home Medicines Review

Background: A significant problem in older people (aged >or=65 years) is the use of potentially inappropriate medications (PIMs), including those with sedative and anticholinergic properties. However, effective intervention strategies have yet to be identified. The Drug Burden Index (DBI) is an evidence-based tool that measures a person's total exposure to medications with sedative and anticholinergic properties and has been shown to be independently associated with impairment in cognitive and physical function.

Objective: The main aim of the study was to investigate whether Home Medicines Review (HMR) services by pharmacists for community-dwelling older people would lead to an improvement in the use of medications, as measured by a decrease in the DBI score. The study also aimed to investigate the (i) distribution of DBI scores and PIMs among older people living in the community, and (ii) impact of pharmacists' recommendations on DBI scores and PIMs.

Methods: A retrospective analysis of medication reviews was performed for 372 community-dwelling older people (aged >or=65 years) who received an HMR service from the pharmacist. The main outcome measure was the total DBI score at baseline and post-HMR. The data were also examined to determine the extent of PIM use (2003 Beers' criteria), and the number and nature of pharmacists' recommendations.

Results: Overall, medications contributing to the DBI (i.e. medications with sedative or anticholinergic properties) and PIMs were identified in 60.5% (n = 225) and 39.8% (n = 148) of the patients, respectively. Following pharmacist recommendations during the HMR service, medications contributing to the DBI were identified in 51.6% (n = 192) of the patients. A statistically significant reduction in the sum total of DBI scores for all patients was observed following pharmacists' recommendations during the HMR service (206.9 vs 157.3, p < 0.001). Pharmacists' recommendations also led to a decrease in the use of PIMs, which were identified in 28.2% (n = 105) of the patients following the HMR service.

Conclusions: When the DBI is used for evaluation, pharmacists' recommendations during HMR services, if acted upon, may effect changes in the prescribing of sedative and anticholinergic medications, thereby substantially reducing the patient's drug burden. Future studies should focus on whether such a decrease may translate into functional improvements. The study also showed a positive influence of HMR services on the prescribing of PIMs.