Home' Australian Pharmacist : Australian Pharmacist March 2013 Contents 54 Australian Pharmacist March 2013 I ©Pharmaceutical Society of Australia Ltd.
Continuing Professional Development
SUPPORTING PHARMACY PRACTICE
Henry may be a candidate for the
deprescribing process. The medications
tagged for deprescribing are included
in Table 3. As mentioned above, the
deprescibing process involves several
healthcare practitioners, of which all
have to be consulted and the medication
regimen agreed with the patient.
Discontinuation symptoms can be avoided
during deprescribing by the slow tapering
of medication according to side effects
The author would like to acknowledge
her supervisors Associate Professor Sarah
Hilmer, Associate Professor Timothy
Chen and Dr Danijela Gnjidic. Associate
Professor Sarah Hilmer, Dr D.E. Mager and
Dr D Abernethy hold a patent for the Drug
Study type Study setting
Increased exposure to high DBI
medications was associated
independently with lower physical
function over 5-years9
Self-care retirement village
GPs prescribing practices)
Intervention did not achieve anticipated
outcomes. DBI decreased in both control
and intervention groups10
Australian older men
Higher DBI (>0) is associated with poorer
physical performance and functional
Australian patients from
residential aged care
facilities recruited for a
trial designed to
determine fall rates
- DBI was only associated with impairment
in balance and not with physical
- DBI is significantly and independently
associated with falls in older people13
- High exposure to DBI affected
medications showed no significant
association between increased DBI and
people in Finland
- DBI was associated with functional
- Exposure to DBI medications was
associated with a greater use of hospital
older people admitted to
geriatric medicine units
Higher DBI scores on admission are
independently associated with length
of hospital stay and lower scores in
Older Australians living in
low-level care facilities
DBI was associated with impairments in
Table 2: Studies of the Drug Burden Index -- the evidence in the literature
Reasons to deprescribe
No indication, inconsistent dosing regimen
Strong opioid for chronic pain causing adverse side effects,
not indicated for osteoarthritis, contributes to DBI
Review need for benzodiazepine, indicated for short-term
management of acute insomnia, contributes to DBI
Review required of condition for deprescribing, contributes to
Table 3: Medications identi ed for deprescribing for Henry
1. Hilmer SN. The dilemma of polypharmacy. Australian Prescriber.
2. AIHW. Older Australia at a glance: 4th Edition. Australian Institute of
Health and Welfare. 2007;Canberra. Cat. No. AGE52.
3. Hovstadius B, Petersson G. Factors Leading to Excessive
Polypharmacy. Clinics in geriatric medicine. 2012;28(2):159--72.
4. Australian Bureau of Statistics. National Health Survey: Summary
of Results 2004--2005. Cat No 4364.0. Commonwealth of Australia,
Canberra: ABS, 2006.
5. Elliott RA. Problems with Medication Use in the Elderly: An
Australian Perspective. Journal of Pharmacy Practice and Research.
6. Hilmer SN, Mager DE, Simonsick EM, Cao Y, Ling SM, Windham
BG, et al. A drug burden index to define the functional burden of
medications in older people. Arch Intern Med. 2007;167(8):781-7.
7. Nishtala PS, Hilmer SN, McLachlan AJ, Hannan PJ, Chen TF. Impact
of residential medication management reviews on drug burden
index in aged-care homes: a retrospective analysis. Drugs Aging.
2009;26(8):677--86. Epub 2009/08/19.
8. Castelino RL, Hilmer SN, Bajorek BV, Nishtala P, Chen TF. Drug Burden
Index and potentially inappropriate medications in community-
dwelling older people: the impact of Home Medicines Review.
Drugs Aging. 2010;27(2):135--48. Epub 2010/01/29.
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TB, et al. Drug burden index score and functional decline in older
people. Am J Med. 2009;122(12):1142-9 e1--2. Epub 2009/12/05.
10. Gnjidic D, Le Couteur DG, Abernethy DR, Hilmer SN. A pilot
randomized clinical trial utilizing the drug burden index to reduce
exposure to anticholinergic and sedative medications in older
people. Ann Pharmacother. 2010;44(11):1725--32. Epub 2010/09/30.
11. Gnjidic D, Cumming RG, Le Couteur DG, Handelsman DJ,
Naganathan V, Abernethy DR, et al. Drug Burden Index and
physical function in older Australian men. Br J Clin Pharmacol.
2009;68(1):97--105. Epub 2009/08/08.
12. Wilson NM, Hilmer SN, March LM, Cameron ID, Lord SR, Seibel MJ, et
al. Associations between drug burden index and physical function
in older people in residential aged care facilities. Age Ageing.
2010;39(4):503--7. Epub 2010/05/27.
13. Wilson NM, Hilmer SN, March LM, Cameron ID, Lord SR, Seibel MJ,
et al. Associations between drug burden index and falls in older
people in residential aged care. J Am Geriatr Soc. 2011;59(5):875--80.
14. Wilson NM, Hilmer SN, March LM, Chen JS, Gnjidic D, Mason RS,
et al. Associations between drug burden index and mortality
in older people in residential aged care facilities. Drugs Aging.
2012;29(2):157--65. Epub 2012/01/27.
15. Gnjidic D, Bell JS, Hilmer SN, Lonnroos E, Sulkava R, Hartikainen
S. Drug Burden Index associated with function in community-
dwelling older people in Finland: A cross-sectional study. Ann Med.
2011. Epub 2011/04/19.
16. Lonnroos E, Gnjidic D, Hilmer SN, Bell JS, Kautiainen H, Sulkava R,
et al. Drug Burden Index and hospitalization among community-
dwelling older people. Drugs Aging. 2012;29(5):395--404. Epub
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Burden Index, Physical Function, and Adverse Outcomes in Older
Hospitalized Patients. J Clin Pharmacol. 2011. Epub 2011/12/15.
18. Gnjidic D, Le Couteur DG, Abernethy DR, Hilmer SN. Drug Burden
Index and Beers Criteria: Impact on Functional Outcomes in Older
People Living in Self-Care Retirement Villages. The Journal of Clinical
19. Hardy JE, Hilmer SN. Deprescribing in the Last year of Life. Journal of
Pharmacy Practice and Research. 2011;41(2):146--51.
20. Woodward MC. Deprescribing: Achieving Better Health Outcomes
for Older People Through Reducing Medications. Journal of
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21. Gnjidic D, Le Couteur DG, Kouladjian L, Hilmer SN. Deprescribing
Trials: Methods to Reduce Polypharmacy and the Impact on
Prescribing and Clinical Outcomes. Clinics in geriatric medicine.
22. Castelino RL, Bajorek BV, Chen TF. Are interventions recommended
by pharmacists during Home Medicines Review evidence-based?
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Zealand College of Anaesthetists and Faculty of Pain Medicine. 2010.
26. Gnjidic D, Hilmer SN, Blyth FM, Naganathan V, Cumming RG,
Handelsman DJ, et al. High-risk prescribing and incidence of frailty
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2012;91(3):521--8. Epub 2012/02/03.
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