Ageing and Pharmacology Laboratory, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, Australia.
Aged Care Department, Royal North Shore Hospital, Sydney, Australia.
J Am Geriatr Soc. 2024 Feb;72(2):589-603. doi: 10.1111/jgs.18691. Epub 2023 Nov 25.
The Drug Burden Index (DBI) measures an individual's total exposure to anticholinergic and sedative medications. This systematic review aimed to investigate the association of the DBI with clinical and prescribing outcomes in observational pharmaco-epidemiological studies, and the effect of DBI exposure on functional outcomes in pre-clinical models.
A systematic search of nine electronic databases, citation indexes and gray literature was performed (April 1, 2007-December 31, 2022). Studies that reported primary data on the association of the DBI with clinical or prescribing outcomes conducted in any setting in humans aged ≥18 years or animals were included. Quality assessment was performed using the Joanna Briggs Institute critical appraisal tools and the Systematic Review Centre for Laboratory animal Experimentation risk of bias tool.
Of 2382 studies screened, 70 met the inclusion criteria (65 in humans, five in animals). In humans, outcomes reported included function (n = 56), cognition (n = 20), falls (n = 14), frailty (n = 7), mortality (n = 9), quality of life (n = 8), hospitalization (n = 7), length of stay (n = 5), readmission (n = 1), other clinical outcomes (n = 15) and prescribing outcomes (n = 2). A higher DBI was significantly associated with increased falls (11/14, 71%), poorer function (31/56, 55%), and cognition (11/20, 55%) related outcomes. Narrative synthesis was used due to significant heterogeneity in the study population, setting, study type, definition of DBI, and outcome measures. Results could not be pooled due to heterogeneity. In animals, outcomes reported included function (n = 18), frailty (n = 2), and mortality (n = 1). In pre-clinical studies, a higher DBI caused poorer function and frailty.
A higher DBI may be associated with an increased risk of falls and decreased function and cognition. Higher DBI was inconsistently associated with increased mortality, length of stay, frailty, hospitalization or reduced quality of life. Human observational findings with respect to functional outcomes are supported by preclinical interventional studies. The DBI may be used as a tool to identify older adults at higher risk of harm.
药物负担指数（DBI）衡量个体接触抗胆碱能和镇静药物的总量。本系统评价旨在调查观察性药物流行病学研究中 DBI 与临床和处方结果的关联，以及 DBI 暴露对临床前模型中功能结果的影响。
对九个电子数据库、引文索引和灰色文献进行了系统检索（2007 年 4 月 1 日-2022 年 12 月 31 日）。纳入的研究报告了 DBI 与临床或处方结果的主要数据，这些研究是在任何环境中针对年龄≥18 岁的人类或动物进行的。使用 Joanna Briggs 研究所的批判性评估工具和系统评价中心的实验室动物实验风险偏倚工具进行质量评估。
在筛选出的 2382 篇研究中，有 70 篇符合纳入标准（65 篇为人类研究，5 篇为动物研究）。在人类中，报告的结果包括功能（n=56）、认知（n=20）、跌倒（n=14）、衰弱（n=7）、死亡率（n=9）、生活质量（n=8）、住院（n=7）、住院时间（n=5）、再入院（n=1）、其他临床结果（n=15）和处方结果（n=2）。较高的 DBI 与跌倒增加（11/14，71%）、功能较差（31/56，55%）和认知相关结果较差（11/20，55%）显著相关。由于研究人群、研究地点、研究类型、DBI 定义和结局测量的显著异质性，采用叙述性综合方法。由于异质性，无法进行汇总。在动物中，报告的结果包括功能（n=18）、衰弱（n=2）和死亡率（n=1）。在临床前研究中，较高的 DBI 导致功能和衰弱较差。
较高的 DBI 可能与跌倒风险增加以及功能和认知下降有关。较高的 DBI 与死亡率、住院时间、衰弱、住院或生活质量降低的增加不一致相关。功能结局的人体观察结果得到了临床前干预研究的支持。DBI 可作为识别高风险伤害的老年人的工具。
