Drug burden index and potentially inappropriate medications in community-dwelling older people: The impact of home medicines review

Ronald L. Castelino, Sarah N. Hilmer, Beata V. Bajorek, Prasad Nishtala, Timothy F. Chen

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Background: A significant problem in older people (aged ≥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 persons 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 ≥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

Original languageEnglish
Pages (from-to)135-148
Number of pages14
JournalDrugs and Aging
Issue number2
Publication statusPublished - 26 Feb 2010


  • Cholinergic-receptor-antagonists, therapeutic use
  • Community-care
  • Elderly
  • Hypnosedatives, therapeutic use
  • Medication-errors
  • Prescribing

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Pharmacology (medical)


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