title: Drug Burden Index score and anticholinergic risk scale as predictors of readmission to the hospital.
abstract: OBJECTIVE
  Determine the association between different measures of drug exposure such as an increased Drug Burden Index (DBI) and a higher Anticholinergic Risk Scale (ARS) score in vulnerable elders and risk of readmission to the hospital.
  
  
  METHODS
  The study is a retrospective cohort comparing ARS and DBI between patients readmitted and not readmitted to the hospital within 30 days of initial admission. Data collected included drugs considered to have anticholinergic, sedative, or both types of properties (Appendix 1), medication strengths, doses per day, patient age, Vulnerable Elders Survey (VES-13) score upon admission, patient diagnoses, and rates of admission.
  
  
  METHODS
  Nonprofit, 838-bed, regional health system of four hospitals.
  
  
  METHODS
  Patients were included in the study if they were admitted to a hospital floor, were 65 years of age or older, were assessed using VES-13, and did not have routinely visiting family to engage them as observed by floor nurses.
  
  
  METHODS
  None; retrospective study.
  
  
  METHODS
  Readmission rate.
  
  
  RESULTS
  The mean difference in DBI and ARS scores were higher in the readmitted group. Hydrocodone and hydroxyzine were the most commonly used drugs in the readmitted group that were considered when determining DBI.
  
  
  CONCLUSIONS
  There is a role for screening and clinical intervention in vulnerable elders using DBI and ARS to help identify those at greatest risk for readmission to the hospital.
authors.affiliation: Charleston Area Medical Center, Charleston, West Virginia.
authors.forename: Rachel
authors.initials: R
authors.lastname: Dispennette
authors.affiliation: Department of Clinical Pharmacy, West Virginia University-Charleston Division, Charleston.
authors.forename: David
authors.initials: D
authors.lastname: Elliott
authors.affiliation: Veterans Affairs North Texas Health Care System, Dallas, Texas.
authors.forename: Lisa
authors.initials: L
authors.lastname: Nguyen
authors.affiliation: Charleston Area Medical Center-General Division, Charleston.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Richmond
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018680:Cholinergic Antagonists / Q000627:therapeutic use*; D006801:Humans; D006853:Hydrocodone / Q000627:therapeutic use; D006919:Hydroxyzine / Q000627:therapeutic use; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012306:Risk; D035862:Vulnerable Populations
chemical_list: D018680:Cholinergic Antagonists; D006993:Hypnotics and Sedatives; D006919:Hydroxyzine; D006853:Hydrocodone
keywords: ACOVE = Assessing Care of Vulnerable Elders; ADL = Activities of daily living; ARS = Anticholinergic Risk Scale; Anticholinergic; DBI = Drug Burden Index; Drug; Drug burden; Elder; Geriatrics; Readmission; STOPP = Screening Tool for Older Persons of Potentially Inappropriate Prescriptions; Sedating; TDB = Total drug burden; VES-13 = Vulnerable Elder Survey; VIP = Volunteers Informing Patients; Vulnerable