ArticlePharmacoepidemiology and drug safety2021
Quantifying cumulative anticholinergic and sedative drug load among US Medicare Beneficiaries.
Article in Pharmacoepidemiology and drug safety, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it, 11 citations in OpenAlex.
- Prevalence and factors associated with anticholinergic medication use in community-dwelling older adults: a systematic review.International journal of clinical pharmacy · 2025Pooled it
- Association between anticholinergic and sedative medications and physical functioning: data from the Canadian longitudinal study on aging (CLSA).European journal of clinical pharmacology · 2026Article
- Anticholinergic and Sedative Medication Burden in Croatian Older Adults: EuroAgeism Cohort Findings.Pharmacy (Basel, Switzerland) · 2025Article
- Assessing the prevalence of anticholinergic and sedative medications to avoid in older adults from the French Health Data System.Journal of the American Geriatrics Society · 2025Article
- Impact of comprehensive medication reviews on potentially inappropriate medication discontinuation in Medicare beneficiaries.Journal of the American Geriatrics Society · 2024Article
- Validating claims-based definitions for deprescribing: Bridging the gap between clinical and administrative data.Pharmacoepidemiology and drug safety · 2024Article
- Progressive Biocatalysts for the Treatment of Aqueous Systems Containing Pharmaceutical Pollutants.Life (Basel, Switzerland) · 2023Review
- Effects of anticholinergic and sedative medication use on fractures: A self-controlled design study.Journal of the American Geriatrics Society · 2021Article
Corrections and comments
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Authors and funding
10 authors at 3 institutions in 2 countries.
Funding
Abstract
purposeMedications with anticholinergic and sedative properties are widely used among older adults despite strong evidence of harm. The drug burden index (DBI), a pharmacological screening tool, measures these properties across drug classes, and higher DBI drug exposure (DBI > 1) has been associated with certain physical function-related adverse events. Our aim was to quantify mean daily DBI drug exposure among older adults in the United States (US).
methodsWe screened medications for DBI properties and operationalized the DBI for US Medicare claims. We then conducted a retrospective cohort study of a 20% random, nationwide sample of 4 137 384 fee-for-service Medicare beneficiaries aged 66+ years (134 757 039 person-months) from January 2013 to December 2016. We measured the monthly distribution based on mean daily DBI, categorized as (a) >0 vs 0 (any use) and (b) 0, 0 < DBI ≤ 1, 1 < DBI ≤ 2, and DBI > 2, and examined temporal trends. We described patient-level factors (eg, demographics, healthcare use) associated with high (>2) vs low (0 < DBI≤1) DBI drug exposure.
resultsThe distribution of the mean daily DBI, aggregated at the month-level, was: 58.1% DBI = 0, 29.0% 0 < DBI≤1, 9.3% 1 < DBI≤2, and 3.7% DBI > 2. Predictors of high monthly DBI drug exposure (DBI > 2) included certain indicators of increased healthcare use (eg, high number of drug claims), white race, younger age, frailty, and a psychosis diagnosis code.
conclusionsThe predictors of high DBI drug exposure can inform discussions between patients and providers about medication appropriateness and potential de-prescribing. Future Medicare-based studies should assess the association between the DBI and adverse events.
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Registered trials
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