You are here

Article Text

Article menu

Download PDFPDF

XML
Geriatric medicine
Research
Anticholinergic and sedative drug burden in community-dwelling older people: a national database study
  1. Catherine J Byrne1,
  2. Caroline Walsh1,
  3. Caitriona Cahir1,
  4. Cristín Ryan2,
  5. David J Williams3,
  6. Kathleen Bennett1
  1. 1 Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
  2. 2 School of Pharmacy and Pharmaceutical Sciences, University of Dublin Trinity College, Dublin, Ireland
  3. 3 Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland and Beaumont Hospital, Dublin, Ireland
  1. Correspondence to Dr Catherine J Byrne; catherinebyrne{at}rcsi.com

Abstract

Objectives The Drug Burden Index (DBI) tool quantifies individual exposure to anticholinergic and sedative medications. The DBI has been internationally validated against adverse health outcomes in older people. DBI exposure has not been reported in the Irish older population. This study aimed to: (1) develop a list of drugs with clinically significant anticholinergic and/or sedative effects (DBI medications) relevant to Ireland; (2) examine, using the DBI formula, the prevalence of exposure to DBI medications in Irish older people and (3) explore patient factors associated DBI exposure.

Design A cross-sectional national pharmacy claims database study.

Setting Community setting using the General Medical Services (GMS) scheme pharmacy claims database maintained by the Health Service Executive Primary Care Reimbursement Services.

Participants Irish older individuals (aged ≥65 years) enrolled in the GMS scheme and dispensed at least one prescription item in 2016 (n=428 516).

Main outcome measures Prevalence of exposure to DBI medications and patient factors associated with DBI exposure.

Results 282 874 (66%) of the GMS population aged ≥65 years were exposed to at least one DBI medication in 2016. Prevalence of exposure to DBI medications was significantly higher in females than males (females 71.6% vs males 58.7%, adjusted OR 1.65, 95% CI 1.63 to 1.68). Prevalence of DBI exposure increased progressively with the number of chronic drugs used, rising from 42.7% of those prescribed 0–4 chronic drugs to 95.4% of those on ≥12 chronic drugs (adjusted OR 27.8, 95% CI 26.7 to 29.0). The most frequently used DBI medications were codeine/paracetamol combination products (20.1% of patients), tramadol (11.5%), zopiclone (9.5%), zolpidem (8.5%), pregabalin (7.9%) and alprazolam (7.8%).

Conclusions The majority of older people in Ireland are exposed to medications with anticholinergic and/or sedative effects, particularly females and those with multiple comorbidities. The high use of low-dose codeine/paracetamol combination products, Z-drugs and benzodiazepines, suggests there are opportunities for deprescribing.

  • drug burden index
  • older people
  • anticholinergic burden
  • sedative burden
  • primary care
  • pharmacoepidemiology

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:©http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-022500

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Contributors CJB and KB conceived and designed the study. CJB, CW, DJW and CR contributed to development of the DBI medication list. KB accessed the data (HSE-PCRS). KB, CJB and CC performed the analysis and interpreted the results. CJB wrote the manuscript. All authors critically revised the manuscript and approved the final version.

    • Funding This work was supported by the Health Research Board in Ireland (grant code RL-2015-1579).

    • Disclaimer The funder had no role in the conduct of the study.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval The anonymised data in this study were exempt from review by an institutional review board.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.