Abstract：
The Drug Burden Index (DBI) measures an individual\'s total exposure to anticholinergic and sedative medications. This systematic review aimed to investigate the association of the DBI with clinical and prescribing outcomes in observational pharmaco-epidemiological studies, and the effect of DBI exposure on functional outcomes in pre-clinical models.
A systematic search of nine electronic databases, citation indexes and gray literature was performed (April 1, 2007-December 31, 2022). Studies that reported primary data on the association of the DBI with clinical or prescribing outcomes conducted in any setting in humans aged ≥18 years or animals were included. Quality assessment was performed using the Joanna Briggs Institute critical appraisal tools and the Systematic Review Centre for Laboratory animal Experimentation risk of bias tool.
Of 2382 studies screened, 70 met the inclusion criteria (65 in humans, five in animals). In humans, outcomes reported included function (n = 56), cognition (n = 20), falls (n = 14), frailty (n = 7), mortality (n = 9), quality of life (n = 8), hospitalization (n = 7), length of stay (n = 5), readmission (n = 1), other clinical outcomes (n = 15) and prescribing outcomes (n = 2). A higher DBI was significantly associated with increased falls (11/14, 71%), poorer function (31/56, 55%), and cognition (11/20, 55%) related outcomes. Narrative synthesis was used due to significant heterogeneity in the study population, setting, study type, definition of DBI, and outcome measures. Results could not be pooled due to heterogeneity. In animals, outcomes reported included function (n = 18), frailty (n = 2), and mortality (n = 1). In pre-clinical studies, a higher DBI caused poorer function and frailty.
A higher DBI may be associated with an increased risk of falls and decreased function and cognition. Higher DBI was inconsistently associated with increased mortality, length of stay, frailty, hospitalization or reduced quality of life. Human observational findings with respect to functional outcomes are supported by preclinical interventional studies. The DBI may be used as a tool to identify older adults at higher risk of harm.
A systematic search of nine electronic databases, citation indexes and gray literature was performed (April 1, 2007-December 31, 2022). Studies that reported primary data on the association of the DBI with clinical or prescribing outcomes conducted in any setting in humans aged ≥18 years or animals were included. Quality assessment was performed using the Joanna Briggs Institute critical appraisal tools and the Systematic Review Centre for Laboratory animal Experimentation risk of bias tool.
Of 2382 studies screened, 70 met the inclusion criteria (65 in humans, five in animals). In humans, outcomes reported included function (n = 56), cognition (n = 20), falls (n = 14), frailty (n = 7), mortality (n = 9), quality of life (n = 8), hospitalization (n = 7), length of stay (n = 5), readmission (n = 1), other clinical outcomes (n = 15) and prescribing outcomes (n = 2). A higher DBI was significantly associated with increased falls (11/14, 71%), poorer function (31/56, 55%), and cognition (11/20, 55%) related outcomes. Narrative synthesis was used due to significant heterogeneity in the study population, setting, study type, definition of DBI, and outcome measures. Results could not be pooled due to heterogeneity. In animals, outcomes reported included function (n = 18), frailty (n = 2), and mortality (n = 1). In pre-clinical studies, a higher DBI caused poorer function and frailty.
A higher DBI may be associated with an increased risk of falls and decreased function and cognition. Higher DBI was inconsistently associated with increased mortality, length of stay, frailty, hospitalization or reduced quality of life. Human observational findings with respect to functional outcomes are supported by preclinical interventional studies. The DBI may be used as a tool to identify older adults at higher risk of harm.
摘要：
背景：药物负担指数（DBI）测量个体对抗胆碱能药物和镇静药物的总暴露量。本系统评价旨在研究观察性药物流行病学研究中DBI与临床和处方结果的关联。以及DBI暴露对临床前模型功能结局的影响。
方法：对九个电子数据库进行系统搜索，引用索引和灰色文献(2007年4月1日-2022年12月31日)。研究报告了在年龄≥18岁的人类或动物中进行的DBI与临床或处方结果的关联的主要数据。使用JoannaBriggs研究所的关键评估工具和实验室动物实验系统审查中心的偏倚风险工具进行质量评估。
结果：在筛选的2382项研究中，70人符合纳入标准(65人，动物中有五个）。在人类中,报告的结果包括功能(n=56)，认知(n=20)，跌倒(n=14)，脆弱(n=7)，死亡率（n=9），生活质量（n=8），住院（n=7），停留时间(n=5)，再入院(n=1)，其他临床结局（n=15）和处方结局（n=2）。较高的DBI与跌倒增加显着相关（11/14，71％），功能较差（31/56，55%），和认知(11/20，55%)相关结果。由于研究人群中的显著异质性，使用了叙事综合，设置,研究类型,DBI的定义，和结果措施。由于异质性，结果无法汇总。在动物中,报告的结果包括功能(n=18)，脆弱(n=2)，死亡率（n=1）。在临床前研究中,较高的DBI导致功能较差和虚弱。
结论：较高的DBI可能与跌倒风险增加以及功能和认知功能下降相关。较高的DBI与死亡率增加不一致，逗留时间,脆弱,住院或生活质量下降。关于功能结果的人类观察结果得到了临床前介入研究的支持。DBI可以用作识别具有较高伤害风险的老年人的工具。
方法：对九个电子数据库进行系统搜索，引用索引和灰色文献(2007年4月1日-2022年12月31日)。研究报告了在年龄≥18岁的人类或动物中进行的DBI与临床或处方结果的关联的主要数据。使用JoannaBriggs研究所的关键评估工具和实验室动物实验系统审查中心的偏倚风险工具进行质量评估。
结果：在筛选的2382项研究中，70人符合纳入标准(65人，动物中有五个）。在人类中,报告的结果包括功能(n=56)，认知(n=20)，跌倒(n=14)，脆弱(n=7)，死亡率（n=9），生活质量（n=8），住院（n=7），停留时间(n=5)，再入院(n=1)，其他临床结局（n=15）和处方结局（n=2）。较高的DBI与跌倒增加显着相关（11/14，71％），功能较差（31/56，55%），和认知(11/20，55%)相关结果。由于研究人群中的显著异质性，使用了叙事综合，设置,研究类型,DBI的定义，和结果措施。由于异质性，结果无法汇总。在动物中,报告的结果包括功能(n=18)，脆弱(n=2)，死亡率（n=1）。在临床前研究中,较高的DBI导致功能较差和虚弱。
结论：较高的DBI可能与跌倒风险增加以及功能和认知功能下降相关。较高的DBI与死亡率增加不一致，逗留时间,脆弱,住院或生活质量下降。关于功能结果的人类观察结果得到了临床前介入研究的支持。DBI可以用作识别具有较高伤害风险的老年人的工具。
