Associations between the drug burden index, potentially inappropriate medications and quality of life in residential aged care

Journal article

Harrison, Stephanie L., Kouladjian O'Donnell, Lisa, Bradley, Clare E., Milte, Rachel, Dyer, Suzanne M., Gnanamanickam, Emmanuel S., Liu, Enwu, Hilmer, Sarah N. and Crotty, Maria. (2018). Associations between the drug burden index, potentially inappropriate medications and quality of life in residential aged care. Drugs and Aging. 35(1), pp. 83-91. https://doi.org/10.1007/s40266-017-0513-3
AuthorsHarrison, Stephanie L., Kouladjian O'Donnell, Lisa, Bradley, Clare E., Milte, Rachel, Dyer, Suzanne M., Gnanamanickam, Emmanuel S., Liu, Enwu, Hilmer, Sarah N. and Crotty, Maria
Abstract

Background
Inappropriate polypharmacy may negatively impact the quality of life of residents in aged care facilities, but it remains unclear which medications may influence this reduced quality of life.

Objective
The objective of this study was to examine whether the Drug Burden Index and potentially inappropriate medications were associated with quality of life in older adults living in residential care with a high prevalence of cognitive impairment and dementia.

Methods
We conducted cross-sectional analyses of 541 individuals recruited from 17 residential aged care facilities in Australia in the Investigating Services Provided in the Residential Environment for Dementia (INSPIRED) study. Quality of life was measured using the EuroQol Five Dimensions Questionnaire (a measure of generic quality of life) and the Dementia Quality of Life Questionnaire completed by the participant or a proxy.

Results
In the 100 days prior to recruitment, 83.1% of the participants received at least one anticholinergic or sedative medication included in the Drug Burden Index and 73.0% received at least one potentially inappropriate medication according to the Beers Criteria. Multi-level linear models showed there was a significant association between a higher Drug Burden Index and lower quality of life according to the EuroQol Five Dimensions Questionnaire [β (standard error): − 0.034 (0.012), p = 0.006] after adjustment for potential confounding factors. Increasing numbers of potentially inappropriate medications were also associated with lower EuroQol Five Dimensions Questionnaire scores [− 0.030 (0.010), p = 0.003] and Dementia Quality of Life Questionnaire-Self-Report-Utility scores [− 0.020 (0.009), p = 0.029]. Exposure to both Drug Burden Index-associated medications and potentially inappropriate medications was associated with lower Dementia Quality of Life Questionnaire-Self-Report-Utility scores [− 0.034 (0.017), p = 0.049].

Conclusion
Exposure to anticholinergic and sedative medications and potentially inappropriate medications occurred in over three-quarters of a population of older adults in residential care and was associated with a lower quality of life.

Keywordsaged; 80 and over; assisted living facilities; Australia; cholinergic antagonists; cognitive dysfunction; cross-sectional studoes; dementia; female; humans; male; inappropriate presecribing; polypharmacy; potentially inappropriate medication list; prevalence; quality of life
Year2018
JournalDrugs and Aging
Journal citation35 (1), pp. 83-91
PublisherAdis International Ltd.
ISSN1170-229X
Digital Object Identifier (DOI)https://doi.org/10.1007/s40266-017-0513-3
Scopus EID2-s2.0-85040346216
Open accessPublished as green open access
Page range83-91
FunderNational Health and Medical Research Council (NHMRC)
Research GroupMary MacKillop Institute for Health Research
Author's accepted manuscript
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Open
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Output statusPublished
Publication dates
Online11 Jan 2018
Grant IDGNT9100000
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A decade of FRAX: How has it changed the management of osteoporosis?
Kanis, John A., Harvey, Nicholas C., Johansson, Helena, Liu, Enwu, Vandenput, Liesbeth, Lorentzon, Mattias, Leslie, William D. and McCloskey, Eugene V.. (2020). A decade of FRAX: How has it changed the management of osteoporosis? Aging Clinical and Experimental Research. 32(2), pp. 187 - 196. https://doi.org/10.1007/s40520-019-01432-y
Use of age-dependent FRAX-based intervention thresholds for Singapore
Kanis, John A., Chandran, Manju, Chionh, Siok Bee, Ganeson, Ganga, Harvey, Nicholas C., Koh, Woon-Puay, Kwok, Timothy, Lau, Tang Ching, Liu, Enwu, Lorentzon, Mattias, McCloskey, Eugene V., Tan, Kelvin Bryan, Vandenput, Liesbeth and Johansson, Helena. (2020). Use of age-dependent FRAX-based intervention thresholds for Singapore. Archives of Osteoporosis. 15, pp. 1 - 10. https://doi.org/10.1007/s11657-020-00782-9
Appendicular lean mass and fracture risk assessment: Implications for FRAX(R) and sarcopenia
Harvey, Nicholas C., Kanis, John A., Liu, Enwu, Johansson, Helena, Lorentzon, Mattias and McCloskey, Eugene. (2019). Appendicular lean mass and fracture risk assessment: Implications for FRAX(R) and sarcopenia. Osteoporosis International. 30(3), pp. 537 - 539. https://doi.org/10.1007/s00198-019-04904-z
Temporal changes in access to FRAX in Thailand between 2010 and 2018
Chotiyarnwong, Pojchong, Harvey, Nicholas C., Johansson, Helena, Liu, Enwu, Lorentzon, Mattias, Kanis, John A. and McCloskey, Eugene V.. (2019). Temporal changes in access to FRAX in Thailand between 2010 and 2018. Archives of Osteoporosis. 14(1), pp. 1 - 7. https://doi.org/10.1007/s11657-019-0613-2
Patterns of medication prescription by dementia diagnosis in Australian nursing home residents: A cross-sectional study
Liu, Enwu, Dyer, Suzanne M., Whitehead, Craig, O'Donnell, Lisa Kouladjian, Gnanamanickam, Emmanuel S., Harrison, Stephanie L., Milte, Rachel and Crotty, Maria. (2019). Patterns of medication prescription by dementia diagnosis in Australian nursing home residents: A cross-sectional study. Journal of Pharmacy Practice and Research. 49(1), pp. 33 - 40. https://doi.org/10.1002/jppr.1457
Alternative staffing structures in a clustered domestic model of residential aged care in Australia
Harrison, Stephanie L., Dyer, Suzanne M., Milte, Rachel, Liu, Enwu, Gnanamanickam, Emmanuel S. and Crotty, Maria. (2019). Alternative staffing structures in a clustered domestic model of residential aged care in Australia. Australasian Journal on Ageing. 38(Suppl 2), pp. 68 - 74. https://doi.org/10.1111/ajag.12674
Should we provide outreach rehabilitation to very old people living in Nursing Care Facilities after a hip fracture? A randomised controlled trial
Crotty, Maria, Killington, Maggie, Liu, Enwu, Cameron, Ian D., Kurrle, Susan, Kaambwa, Billingsley, Davies, Owen, Miller, Michelle D., Chehade, Mellick and Ratcliffe, Julie. (2019). Should we provide outreach rehabilitation to very old people living in Nursing Care Facilities after a hip fracture? A randomised controlled trial. Age and Ageing. 48(3), pp. 373 - 380. https://doi.org/10.1093/ageing/afz005
Clustered domestic residential aged care in Australia: fewer hospitalisations and better quality of life
Dyer, Suzanne M., Liu, Enwu, Gnanamanickam, Emmanuel S., Milte, Rachel, Easton, Tiffany, Harrison, Stephanie L., Bradley, Clare E., Ratcliffe, Julie and Crotty, Maria. (2018). Clustered domestic residential aged care in Australia: fewer hospitalisations and better quality of life. Medical Journal of Australia. 208(10), pp. 433 - 438. https://doi.org/10.5694/mja17.00861
Direct health and residential care costs of people living with dementia in Australian residential aged care
Gnanamanickam, Emmanuel S., Dyer, Suzanne M., Milte, Rachel, Harrison, Stephanie L., Liu, Enwu, Easton, Tiffany, Bradley, Clare, Bilton, Rebecca, Shulver, Wendy, Ratcliffe, Julie, Whitehead, Craig and Crotty, Maria. (2018). Direct health and residential care costs of people living with dementia in Australian residential aged care. International Journal of Geriatric Psychiatry. 33(7), pp. 859 - 866. https://doi.org/10.1002/gps.4842
Psychotropic medications in older people in residential care facilities and associations with quality of life: a cross-sectional study
Harrison, Stephanie L., Bradley, Clare E., Milte, Rachel, Liu, Enwu, O'Donnell, Lisa K., Hilmer, Sarah N. and Crotty, Maria. (2018). Psychotropic medications in older people in residential care facilities and associations with quality of life: a cross-sectional study. BMC Geriatrics. 18(60), pp. 1 - 8. https://doi.org/10.1186/s12877-018-0752-0
Costs of potentially inappropriate medication use in residential aged care facilities
Harrison, S. L., O'Donnell, L. K., Milte, R., Dyer, S. M., Gnanamanickam, E. S., Bradley, C., Liu, Enwu, Hilmer, S. N. and Crotty, M.. (2018). Costs of potentially inappropriate medication use in residential aged care facilities. BMC Geriatrics. 18(9), pp. 1 - 10. https://doi.org/10.1186/s12877-018-0704-8
Diagnosis of dementia in residential aged care settings in Australia: An opportunity for improvements in quality of care?
Dyer, Suzanne M., Gnanamanickam, Emmanuel S., Liu, Enwu, Whitehead, Craig and Crotty, Maria. (2018). Diagnosis of dementia in residential aged care settings in Australia: An opportunity for improvements in quality of care? Australasian Journal on Ageing. 37(4), pp. e155 - e158. https://doi.org/10.1111/ajag.12580
Clustered domestic model of residential care is associated with better consumer rated quality of care
Gnanamanickam, Emmanuel S., Dyer, Suzanne M., Milte, Rachel, Liu, Enwu, Ratcliffe, Julie and Crotty, Maria. (2018). Clustered domestic model of residential care is associated with better consumer rated quality of care. International Journal for Quality in Health Care. https://doi.org/10.1093/intqhc/mzy181
An empirical comparison of the EQ-5D-5L, DEMQOL-U and DEMQOL-Proxy-U in a post-hospitalisation population of frail older people living in residential aged care
Ratcliffe, Julie, Flint, Thomas, Easton, Tiffany, Killington, Maggie, Cameron, Ian, Davies, Owen, Whitehead, Craig, Kurrle, Susan, Miller, Michelle D., Liu, Enwu and Crotty, Maria. (2017). An empirical comparison of the EQ-5D-5L, DEMQOL-U and DEMQOL-Proxy-U in a post-hospitalisation population of frail older people living in residential aged care. Applied Health Economics and Health Policy. 15(3), pp. 399 - 412. https://doi.org/10.1007/s40258-016-0293-7
Association of cardiovascular system medications with cognitive function and dementia in older adults living in nursing homes in Australia
Liu, Enwu, Dyer, Suzanne M., O'Donnell, Lisa Kouladjian, Milte, Rachel, Bradley, Clare E., Harrison, Stephanie L., Gnanamanickam, Emmanuel S., Whitehead, Craig and Crotty, Maria. (2017). Association of cardiovascular system medications with cognitive function and dementia in older adults living in nursing homes in Australia. Journal of Geriatric Cardiology. 14(6), pp. 407 - 415. https://doi.org/10.11909/j.issn.1671-5411.2017.06.009
Early supported discharge by caregiver-mediated exercise and e-Health support after stroke - A proof-of-concept trial
Van Den Berg, Maayken, Crotty, Maria, Liu, Enwu, Killington, Maggie, Kwakkel, Gert and van Wegen, Erwin. (2016). Early supported discharge by caregiver-mediated exercise and e-Health support after stroke - A proof-of-concept trial. Stroke. 47(7), pp. 1885 - 1892. https://doi.org/10.1161/STROKEAHA.116.013431
Hemiplegic shoulder pain reduces quality of life after acute stroke - A prospective population-based study
Adey-Wakeling, Zoe, Liu, Enwu, Crotty, Maria, Leyden, James, Kleinig, Timothy, Anderson, Craig and Newbury, Jonathon. (2016). Hemiplegic shoulder pain reduces quality of life after acute stroke - A prospective population-based study. American Journal of Physical Medicine and Rehabilitation. 95(10), pp. 758 - 763. https://doi.org/10.1097/PHM.0000000000000496
New South Wales Child Development Study (NSW-CDS): An Australian multiagency, multigenerational, longitudinal record linkage study
Carr, Vaughan J., Harris, Felicity, Raudino, Alessandra, Luo, Luming, Kariuki, Maina, Liu, Enwu, Tzoumakis, Stacy, Smith, Maxwell, Holbrook, Allyson, Bore, Miles, Brinkman, Sally, Lenroot, Rhoshel, Dix, Katherine, Dean, Kimberlie, Laurens, Kristin R. and Green, Melissa J.. (2016). New South Wales Child Development Study (NSW-CDS): An Australian multiagency, multigenerational, longitudinal record linkage study. BMJ Open. 6(2), pp. 1 - 9. https://doi.org/10.1136/bmjopen-2015-009023
Hospital admission for infection during early childhood influences developmental vulnerabilities at age 5 years
Kariuki, Maina, Raudino, Alessandra, Green, Melissa, Laurens, Kristin, Dean, Kimberlie, Brinkman, Sally, Lenroot, Rhoshel, Liu, Enwu, Harris, Felicity, Luo, Luming and Carr, Vaughn J.. (2016). Hospital admission for infection during early childhood influences developmental vulnerabilities at age 5 years. Journal of Paediatrics and Child Health. 52(9), pp. 882 - 888. https://doi.org/10.1111/jpc.13239
Hospital admission for infection during early childhood influences developmental vulnerabilities at age 5 years
Kariuki, Maina, Raudino, Alessandra, Green, Melissa J., Laurens, Kristin R., Dean, Kimberlie, Brinkman, Sally A., Lenroot, Rhoshel K., Liu, Enwu, Harris, Felicity, Luo, Luming and Carr, Vaughn J.. (2016). Hospital admission for infection during early childhood influences developmental vulnerabilities at age 5 years. Journal of Paediatrics and Child Health. 52(9), pp. 882 - 888. https://doi.org/10.1111/jpc.13239
New South Wales child development study (NSW-CDS): An Australian multiagency, multigenerational, longitudinal record linkage study
Carr, Vaughn J., Harris, Felicity, Raudino, Alessandra, Luo, Luming, Kariuki, Maina, Liu, Enwu, Tzoumakis, Stacy, Smith, Maxwell, Holbrook, Allyson, Bore, Miles, Brinkman, Sally, Lenroot, Rhoshel, Dix, Katherine, Dean, Kimberlie, Laurens, Kristin R. and Green, Melissa J.. (2016). New South Wales child development study (NSW-CDS): An Australian multiagency, multigenerational, longitudinal record linkage study. BMJ Open. 6(2), pp. 1 - 9. https://doi.org/10.1136/bmjopen-2015-009023
Baseline HCV antibody prevalence and risk factors among drug users in China's National Methadone Maintenance Treatment Program
Wang, Changhe, Shi, Cynthia X., Rou, Keming, Zhao, Yan, Cao, Xiaobin, Luo, Wei, Liu, Enwu and Wu, Zunyou. (2016). Baseline HCV antibody prevalence and risk factors among drug users in China's National Methadone Maintenance Treatment Program. PLoS ONE. 11(2), pp. 1 - 14. https://doi.org/10.1371/journal.pone.0147922
Who uses methadone services in China? Monitoring the world's largest methadone programme
Sullivan, Sheena G., Wu, Zunyou, Rou, Keming, Pang, Lin, Luo, Wei, Wang, Changhe, Cao, Xiaobin, Yin, Wenyuan, Liu, Enwu and Mi, Guodong. (2015). Who uses methadone services in China? Monitoring the world's largest methadone programme. Addiction. 110(Suppl. 1), pp. 29 - 39. https://doi.org/10.1111/add.12781
Continued drug use during methadone treatment in China: A retrospective analysis of 19,026 service users
Sullivan, Sheena G., Wu, Zunyou, Cao, Xiaobin, Liu, Enwu and Detels, Roger. (2014). Continued drug use during methadone treatment in China: A retrospective analysis of 19,026 service users. Journal of Substance Abuse Treatment. 47(1), pp. 86 - 92. https://doi.org/10.1016/j.jsat.2013.12.004
Referring heroin users from compulsory detoxification centers to community methadone maintenance treatment : A comparison of three models
Yan, Liping, Liu, Enwu, McGoogan, Jennifer M., Duan, Song, Wu, Li-Tzy, Comulada, Scott and Wu, Zunyou. (2013). Referring heroin users from compulsory detoxification centers to community methadone maintenance treatment : A comparison of three models. BMC Public Health. 13(1), pp. 1-8. https://doi.org/10.1186/1471-2458-13-747
HIV and syphilis prevalence among men who have sex with men : A cross-sectional survey of 61 cities in China
Wu, Zunyou, Xu, Jie, Liu, Enwu, Mao, Yurong, Xiao, Yan, Sun, Xinhua, Liu, Yufen, Jiang, Yan, McGoogan, Jennifer M., Dou, Zhi, Mi, Guodong, Wang, Ning, Sun, Jiangping, Liu, Zhongfu, Wang, Lu, Rou, Keming, Pang, Lin, Xing, Wenge, Xu, Juan, ... National MSM Survey Group. (2013). HIV and syphilis prevalence among men who have sex with men : A cross-sectional survey of 61 cities in China. Clinical Infectious Diseases. 57(2), pp. 298-309. https://doi.org/10.1093/cid/cit210
Factors associated with mortality of HIV-positive clients receiving methadone maintenance treatment in China
Liu, Enwu, Rou, Keming, McGoogan, Jennifer M., Pang, Lin, Cao, Xiaobin, Wang, Changhe, Luo, Wei, Sullivan, Sheena G., Montaner, Julio S. G., Bulterys, Marc, Detels, Roger, Wu, Zunyou and China’s National Working Group on Methadone Maintenance Treatment. (2013). Factors associated with mortality of HIV-positive clients receiving methadone maintenance treatment in China. Journal of Infectious Diseases. 3(1), pp. 442-453. https://doi.org/10.1093/infdis/jit163
Antiretroviral therapy to prevent HIV transmission in serodiscordant couples in China (2003-11) : A national observational cohort study
Jia, Zhongwei, Mao, Yurong, Zhang, Fujie, Ruan, Yuhua, Ma, Ye, Li, Jian, Guo, Wei, Liu, Enwu, Dou, Zhihui, Zhao, Yan, Wang, Lu, Li, Qianqian, Xie, Peiyan, Tang, Houlin, Han, Jing, Jin, Xia, Xu, Juan, Xiong, Ran, Zhao, Decai, ... Shao, Yiming. (2013). Antiretroviral therapy to prevent HIV transmission in serodiscordant couples in China (2003-11) : A national observational cohort study. The Lancet. 382(9899), pp. 1195-1203. https://doi.org/10.1016/S0140-6736(12)61898-4