title: Quantification of anticholinergic and sedative drug load with the Drug Burden Index: a review of outcomes and methodological quality of studies.
abstract: OBJECTIVE
  The Drug Burden Index (DBI) is a non-invasive method to quantify patients' anticholinergic and sedative drug burden from their prescriptions. This systematic review aimed to summarise the evidence on the associations between the DBI and clinical outcomes and methodological quality of studies.
  
  
  METHODS
  A search in PubMed and Embase (search terms: 'drug', 'burden', and 'index') was performed and experts were contacted. We excluded publications that did not report empirical results or clinical outcomes. Methodological quality was assessed using the Newcastle-Ottawa Scale. Potential omissions of relevant clinical outcomes and populations were studied.
  
  
  RESULTS
  Of the 2998 identified publications, 21 were eligible. Overall, methodological quality of studies was good. In all but one study, adjustment was made for prevalent co-morbidity. The DBI was examined in diverse older individuals, i.e. both males and females from different settings and countries. However, no studies were conducted in other relevant patient groups, e.g. psychiatric patients. Exposure to anticholinergic and sedative drugs was thoroughly ascertained, though the specific calculation of the DBI differed across studies. Outcomes were assessed from medical records, record linkage or validated objective tests or questionnaires. Many studies found associations between the DBI and outcomes including hospitalisation, physical and cognitive function. Cognitive function and quality of life were understudied and the number and scope of longitudinal studies was limited.
  
  
  CONCLUSIONS
  An accumulating body of evidence supports the validity of the DBI. Longitudinal studies of cognitive function and quality of life and in other patient groups, e.g. psychiatric patients, are warranted.
authors.affiliation: Department of PharmacoTherapy, -Epidemiology & -Economics [PTEE], Groningen Research Institute of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, Netherlands. h.wouters@rug.nl.
authors.forename: Hans
authors.initials: H
authors.lastname: Wouters
authors.affiliation: Department of PharmacoTherapy, -Epidemiology & -Economics [PTEE], Groningen Research Institute of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, Netherlands.
authors.forename: Helene
authors.initials: H
authors.lastname: van der Meer
authors.affiliation: Department of PharmacoTherapy, -Epidemiology & -Economics [PTEE], Groningen Research Institute of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, Netherlands.
authors.forename: Katja
authors.initials: K
authors.lastname: Taxis
mesh_terms: D000368:Aged; D018680:Cholinergic Antagonists / Q000493:pharmacokinetics / Q000494:pharmacology*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000493:pharmacokinetics / Q000494:pharmacology*; D008297:Male; D008498:Medical Record Linkage; D019338:Polypharmacy
chemical_list: D018680:Cholinergic Antagonists; D006993:Hypnotics and Sedatives
keywords: Antimuscarinic agents; Hypnotics and sedatives; Inappropriate prescribing; Older adults, frailty; Polypharmacy