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Published in: Drugs & Aging 1/2019

01-01-2019 | Original Research Article

Is the Drug Burden Index Related to Declining Functional Status at Follow-up in Community-Dwelling Seniors Consulting for Minor Injuries? Results from the Canadian Emergency Team Initiative Cohort Study

Authors: Edeltraut Kröger, Marilyn Simard, Marie-Josée Sirois, Marianne Giroux, Caroline Sirois, Lisa Kouladjian-O’Donnell, Emily Reeve, Sarah Hilmer, Pierre-Hugues Carmichael, Marcel Émond

Published in: Drugs & Aging | Issue 1/2019

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Abstract

Background

The Canadian Emergency Team Initiative (CETI) cohort showed that minor injuries like sprained ankles or small fractures trigger a downward spiral of functional decline in 16% of independent seniors up to 6 months post-injury. Such seniors frequently receive medications with sedative or anticholinergic properties. The Drug Burden Index (DBI), which summarises the drug burden of these specific medications, has been associated with decreased physical and cognitive functioning in previous research.

Objectives

We aimed to assess the contribution of the DBI to functional decline in the CETI cohort.

Methods

CETI participants were assessed physically and cognitively at baseline during their consultations at emergency departments (EDs) for their injuries and up to 6 months thereafter. The medication data were used to calculate baseline DBI and functional status was measured with the Older Americans Resources and Services (OARS) scale. Multivariate linear regression models assessed the association between baseline DBI and functional status at 6 months, adjusting for age, sex, baseline OARS, frailty level, comorbidity count, and mild cognitive impairment.

Results

The mean age of the 846 participants was 77 years and their mean DBI at baseline was 0.24. Complete follow-up data at 3 or 6 months was available for 718 participants among whom a higher DBI at the time of injury contributed to a lower functional status at 6 months. Each additional point in the DBI lead to a loss of 0.5 points on the OARS functional scale, p < 0.001. Among those with a DBI ≥ 1, 27.4% were considered ‘patients who decline’ at 3 or 6 months’ follow-up, compared with 16.0% of those with a DBI of 0 (p = 0.06).

Conclusions

ED visits are considered missed opportunities for optimal care interventions in seniors; Identifying their DBI and adjusting treatment accordingly may help limit functional decline in those at risk after minor injury.
Appendix
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Metadata
Title
Is the Drug Burden Index Related to Declining Functional Status at Follow-up in Community-Dwelling Seniors Consulting for Minor Injuries? Results from the Canadian Emergency Team Initiative Cohort Study
Authors
Edeltraut Kröger
Marilyn Simard
Marie-Josée Sirois
Marianne Giroux
Caroline Sirois
Lisa Kouladjian-O’Donnell
Emily Reeve
Sarah Hilmer
Pierre-Hugues Carmichael
Marcel Émond
Publication date
01-01-2019
Publisher
Springer International Publishing
Published in
Drugs & Aging / Issue 1/2019
Print ISSN: 1170-229X
Electronic ISSN: 1179-1969
DOI
https://doi.org/10.1007/s40266-018-0604-9

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