Araştırma Makalesi

DOI :10.26650/IstanbulJPharm.2022.1139776   IUP :10.26650/IstanbulJPharm.2022.1139776    Tam Metin (PDF)

The drug burden index medication use in older people in north-east Nigeria

Roland Nnaemeka OkoroAlgoni Idris

Background and Aims: Evidence has shown that physical and cognitive impairment in older people is linked with the Drug Burden Index (DBI). The study aimed to describe the prescription pattern of DBI medications, estimate the frequency of contraindicated DBI medication use, determine the rate of exposure to high-risk DBI medications, and identify the potential predictors of exposure to high-risk DBI medications.. Methods: This one-year retrospective study was conducted in a secondary healthcare facility. It included patients over 65 years of age who were prescribed at least one anticholinergic and/or sedative medication. The study data were summarized using descriptive statistics, while multivariable logistic regression analysis was used to identify potential predictors of exposure to high-risk DBI medications. Statistically, a significant level was set at p < 0.05. Results: Most patients were exposed to cardiovascular drugs (57.5%) followed by antihistamines (25.8%). A total of 23 (6.3%) contraindicated DBI medications were identified. Sixty (19.6%) older patients were prescribed high-risk DBI medications. Patients over 70 years were 3.08 times significantly more likely to be exposed to high-risk DBI medications. Also, patients with a low number of non-DBI co-medications (adjusted odds ratio [AOR] 3.40, 95% CI 1.03 - 11.23), polypharmacy (AOR 7.38, 95% CI 2.20 – 24.73), and those that had contraindicated DBI medications (AOR 3.93, 95% CI 1.14 – 13.53) were significantly more likely to be exposed to high-risk DBI medications. Conclusion: The study demonstrated that most older people in the study were exposed to anticholinergic medications. A considerable proportion of these older people were exposed to contraindicated and high-risk DBI medications. Patients over 70 years of age, a low number of non-DBI co-medications, polypharmacy, and contraindicated DBI prescriptions were the significant predictors of exposure to high-risk DBI medications.

PDF Görünüm


  • Akande-Sholabi, W., Adebusoye, L., & Olowookere, O. (2018). Polypharmacy and factors associated with their prevalence among older patients attending a geriatric centre in South-west Nigeria. West African Journal of Pharmacy, 29, 35-45. google scholar
  • Al Hamid, A., Ghaleb, M., Aljadhey, H., & Aslanpour, Z. (2013). A systematic review of hospitalization resulting from medicine-related problems in adult patients. British Journal of Clinical Pharmacology, 78, 202-217. google scholar
  • Alhawassi, T.M., Alatawi, W., & Alwhaibi, M. (2019). Prevalence of potentially inappropriate medications use among older adults and risk factors using the 2015 American Geriatrics Society Beers criteria. BMC Geriatrics, 19, 154. Doi. s12877-019-1168-1. google scholar
  • Assefa, Y.A., Kedir, A., & Kahaliw, W. (2020). Survey on Polypharmacy and drug-drug interactions among elderly people with cardiovascular diseases at Yekatit 12 Hospital, Addis Ababa, Ethiopia. Integrated Pharmacy Research and Practice, 9, 1-9. google scholar
  • Best, O., Gnjidic, D., Hilmer, S.N., Naganathan, V., & McLachlan, A.J. (2013). Investigating polypharmacy and drug burden index in hospitalised older people. Internal Medicine Journal, 43, 912-918. google scholar
  • Bosboom, P.R., Alfonso, H., Almeida, O.P., & Beer, C.l. (2012). Use of Potentially Harmful Medications and Health-Related Quality of Life among People with Dementia Living in Residential Aged Care Facilities. Dementia and Geriatric Cognitive Disorders Extra, 2, 361-371. google scholar
  • Byrne, C.J., Walsh, C., Cahir, C., Ryan, C., Williams, D.J., & Bennett, K. (2018). Anticholinergic and sedative drug burden in communitydwelling older people: a national database study. BMJ Open, 8, e022500. doi:10.1136/bmjopen-2018-022500 google scholar
  • Cao, Y.J., Mager, D.E., Simonsick, E.M., Hilmer, S.N., Ling, S.M., Windham, B.G.,.........Abernethy, D.R. (2008). Physical and cognitive performance and burden of anticholinergics, sedatives, and ACE inhibitors in older women. Clinical Pharmacology & Therapeutics, 83, 422-429. google scholar
  • Cumming, R.G., & Le Couteur, D.G. (2003). Benzodiazepines and risk of hip fractures in older people: a review of the evidence. CNS Drugs, 17, 825-837. google scholar
  • Dauphinot, V., Faure, R., Omrani, S., Goutelle, S., Bourguignon, L., Krolak-Salmon, P., & Mouchoux, C. (2014). Exposure to Anticholinergic and Sedative Drugs, Risk of Falls, and Mortality: An Elderly Inpatient, Multicenter Cohort. Journal of Clinical Psychopharmacology, 34, 565-570. google scholar
  • Essential Medicine Index (EMDEX). (2019). Drug information for Nigeria’s healthcare professionals. 2019 - 2020Ed. Nigeria: Lindoz Products Ltd. google scholar
  • Fick, D.M., Mion, L.C., Beers, M.H., Waller, J.L. (2008). Health outcomes associated with potentially inappropriate medication use in older adults. Research in Nursing & Health, 31, 42-51. google scholar
  • Fillenbaum, G.G., Hanlon, J.T., Landerman, L.R., Artz, M.B., O’Connor, H., Dowd, B.,......Schmader, K.E. (2004). Impact of in google scholar
  • appropriate drug use on health services utilization among representative older community-dwelling residents. American Journal of Geriatric Pharmacotherapy, 2, 92-101. google scholar
  • Garfinkel, D., & Mangin, D. (2010). Feasibility study of a systematic approach for discontinuation of multiple medications in older adults: addressing polypharmacy. Archives of Internal Medicine, 170, 1648-1654. google scholar
  • Glass, J., Lanctôt, K.L., Herrmann, N., Sproule, B.A., Busto, U.E. (2005). Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ, 331, 1169.doi: 10.1136/ bmj.38623.768588.47. google scholar
  • Gnjidic, D., Cumming, R.G., Le Couteur, D.G., Handelsman, D.J., Na-ganathan, V., Abernethy, D.R., & Hilmer, SN. (2009). Drug Burden Index and physical function in older Australian men. British Journal of Clinical Pharmacology, 68, 97-105. google scholar
  • Gnjidic, D., Hilmer, S.N., Hartikainen, S., Tolppanen, A.M., Taipale, H., Koponen, M., & Bell, J.S. (2013). Impact of high risk drug use on hospitalization and mortality in older people with and without Alzheimer’s disease: A national population cohort study. PLoS ONE, e83224. Doi:10.1371/journal.pone.0083224 google scholar
  • Gnjidic, D., Le Couteur, D.G., Abernethy, D.R., & Hilmer, S.N. (2012). Drug burden index and beers criteria: impact on functional outcomes in older people living in self-care retirement villages. Journal of Clinical Pharmacology, 52, 258-265. google scholar
  • Han, L., Agostini, J.V., & Allore, H.G. (2008). Cumulative anticholinergic exposure is associated with poor memory and executive function in older men. Journal of the American Geriatrics Society, 56, 2203-2210. google scholar
  • Hartikainen, S., Lonnroos, E., & Louhivuori, K. (2007). Medication as a risk factor for falls: critical systematic review. Journals of gerontology. Series A, Biological Sciences and Medical Sciences, 62, 11721181. google scholar
  • Hilmer SN, Mager DE, Simonsick EM, Cao Y, Ling SM, Windham BG,......Abernethy, D.R. (2007). A drug burden index to define the functional burden of medications in older people. Archives of Internal Medicine, 23, 167(8):781-787. google scholar
  • Hilmer, S.N., Mager, D.E., Simonsick, E.M., Ling, S.M., Windham, B.G., Harris, T.B.,......Health ABC Study. (2009). Drug burden index score and functional decline in older people. American Journal of Medicine, 122, 1142-1149. google scholar
  • Hilmer, S.N., McLachlan, A.J., & Le Couteur, D.G. (2007). Clinical pharmacology in the geriatric patient. Fundamental & Clinical Pharmacology, 21, 217-230. google scholar
  • Jamieson, H.A., Nishtala, P.S., Scrase, R., Deely, J.M., Abey-Nesbit, R., Connolly, M.J.,......Schluter PJ. (2018). Drug burden and its asso ciation with falls among older adults in New Zealand: a national population cross sectional study. Drugs Aging, 35, 73-81. google scholar
  • Klarin, I., Wimo, A., & Fastbom, J. (2005). The association of inappropriate drug use with hospitalisation and mortality: a population-based study of the very old. Drugs Aging, 22, 69-82. google scholar
  • Kouladjian, L., Gnjidic, D., Chen, T.F., Mangoni, A.A., & Hilmer, S.N. (2014). Drug Burden Index in older adults: theoretical and practical issues. Clinical Interventions in Aging, 9, 1503-1515. google scholar
  • Landi, F., Russo, A., Liperoti, R., Cesari, M., Barillaro, C., Pahor, M., Bernabei, R., & Onder, G. (2007). Anticholinergic drugs and physical function among frail elderly population. Clinical Pharmacology & Therapeutics, 81, 235-241. google scholar
  • Le Couteur, D.G., McLachlan, A.J., & de Cabo, R. (2012). Aging, drugs and drug metabolism. Journal of Gerontology, 67A, 137-139. Lechevallier-Michel, N., Molimard, M., Dartigues, J.F., Fabrigoule, C., & Fourrier-Reglat, A. (2005). Drugs with anticholinergic properties and cognitive performance in the elderly: results from the PA-QUID Study. British Journal of Clinical Pharmacology, 59, 143-151. google scholar
  • Leendertse, A.J., Egberts, A.C., Stoker, L.J., van den Bemt, P.M., & HARM Study Group. (2008). Frequency of and risk factors for preventable medication-related hospital admissions in the Netherlands. Archives of Internal Medicine, 168, 1890-1896. google scholar
  • Lo"nnroos, E., Gnjidic, D., Hilmer, S.N., Bell, J.B., Kautiainen, H., Sul-kava, R., & Hartikainen, S. (2012). Drug Burden Index and Hospitalization among Community-Dwelling Older People. Drugs Aging, 29, 395-404. google scholar
  • Lowry, E., Woodman, R.J., Soiza, R.L., Hilmer, S.N., & Mangoni, A.A. (2011). Drug Burden Index, physical function, and adverse outcomes in older hospitalized patients. Journal of Clinical Pharmacology, 52, 1584-1591. google scholar
  • Mannesse, C.K., Derkx, F.H., de Ridder, M.A., Man in‘t Veld, A.J., & van der Cammen, T.J. (2000). Contribution of adverse drug reactions to hospital admission of older people. Age Ageing, 29, 35-39. McLean, A.J., & Le Couteur, D.G. (2004). Aging biology and geriatric clinical pharmacology. Pharmacological Reviews, 56, 163-184. google scholar
  • Mulsant, B.H., Pollock, B.G., Kirshner, M., Shen, C., Dodge, H., Gan-guli, M. (2003). Serum anticholinergic activity in a communitybased sample of older adults: relationship with cognitive performance. Archives of General Psychiatry, 60, 198-203. google scholar
  • Nebes, R.D., Pollock, B.G., Halligan, E.M., Kirshner, M.A., & Houck, P.R. (2007). Serum anticholinergic activity and motor performance in elderly persons. Journals of gerontology. Series A, Biological Sciences and Medical Sciences, 62, 83-85. google scholar
  • Ness, J., Hoth, A., Barnett, M.J., Shorr, R.I, & Kaboli, P.J. (2006). Anticholinergic medications in community-dwelling older veterans: prevalence of anticholinergic symptoms, symptom burden, and adverse drug events. American Journal of Geriatric Pharmacotherapy, 4, 42-51. google scholar
  • Nishtala, P.S., Narayan, S.W., Wang, T., & Hilmer, S.N. (2014). Associations of drug burden index with falls, general practitioner visits, and mortality in older people. Pharmacoepidemiology and Drug Safety, 23, 753-758. google scholar
  • O’Connell, J., Burke, £., Mulryan, N., O’Dwyer, C., Donegan, C., Mc-Callion, P,, O’Dwyer M, (2018), Drug burden index to define the burden of medicines in older adults with intellectual disabilities: An observational cross-sectional study, British Journal of Clinical Pharmacology, 84, 553-567. google scholar
  • Okoro, R.N. & Shekari, B.G. (2013). Physicians’ Drug Prescribing Patterns at the National Health Insurance Scheme Unit of a Teaching Hospital in the North Eastern Nigeria. Archives of Pharmacy Practice, 4, 3-8. google scholar
  • Olivier, P., Bertrand, L., Tubery, M., Lauque, D., Montastruc, J.L., Lap-eyre-Mestre. M. (2009). Hospitalizations because of adverse drug reactions in elderly patients admitted through the emergency department: a prospective survey. Drugs Aging, 26, 475-482. google scholar
  • Onder, G., Pedone, C., Landi, F., Cesari, M., Della Vedova, C., Bernabei, R., & Gambassi, G. (2002). Adverse drug reactions as cause of hospital admissions: results from the Italian Group of Pharmacoepidemiology in the Elderly (GIFA). Journal of the American Geriatrics Society, 50, 1962-1968. google scholar
  • Saka, S.A., Oosthuizen, F., & Nlooto, M. (2018). An evaluation of potential inappropriate prescribing among older persons in Nigeria. Global Journal of Health Science, 10, 1-28. google scholar
  • Salahudeen, M.S., Hilmer, S.N., & Nishtala, P.S. (2015). Comparison of Anticholinergic Risk Scales and Associations with Adverse Health Outcomes in Older People. Journal of the American Geriatrics Society, 63, 85-90. google scholar
  • Seixas, B.V., & Freitas, G.R. (2021). Polypharmacy among older Brazilians: prevalence, factors associated, and sociodemographic disparities (ELSI-Brazil). Pharmacy Practice (Granda [Internet], 19, 2168. Doi: google scholar
  • Sumukadas, D., McMurdo, M.E., Mangoni, A.A., & Guthrie, B. (2014). Temporal trends in anticholinergic medication prescription in older people: repeated cross-sectional analysis of population prescribing data. Age Ageing, 43, 515-521. google scholar
  • The American Geriatrics Society (AGS). (2019). American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. Journal of the American Geriatrics Society, 00, 1-21. google scholar
  • Tinetti, M.E., Bogardus, S.T Jr., Agostini, J.V. (2004). Potential pitfalls of disease specific guidelines for patients with multiple conditions. New England Journal of Medicine, 351, 2870-2874. google scholar
  • Wilson, N.M., Hilmer, S.N., March, L.M., Cameron, I.D., Lord, S.R., Seibel, MJ.,......Sambrook, P.N. (2011), Associations between Drug google scholar
  • Burden Index and Falls in Older People in Residential Aged Care. Journal of the American Geriatrics Society,59, 875-880. google scholar
  • Wouters, H., van der Meer, H., & Taxis, K. (2017). Quantification of anticholinergic and sedative drug load with the Drug Burden Index: a review of outcomes and methodological quality of studies. European Journal of Clinical Pharmacology, 73, 257-266. google scholar
  • Wouters, H., Hilmer, S.N., Twisk, J., Teichert, M., Van Der Meer, H.G., Van Hout, H.P.J., & Taxis, K. (2020). Drug Burden Index and Cognitive and Physical Function in Aged Care Residents: A Longitudinal Study. Journal of the American Medical Directors Association, 21, 1086-1092. google scholar
  • Xue, Q.L. (2011). The frailty syndrome: definition and natural history. Clinics in Geriatric Medicine, 27, 1-15. google scholar
  • Zhang, X., Zhou, S., Li, X., & Zhou, W. (2019). Anticholinergic and sedative medications exposure in older patients: a cross-sectional study. International Journal of Clinical Pharmacy, 41, 1152-1158. google scholar


Biçimlendirilmiş bir atıfı kopyalayıp yapıştırın veya seçtiğiniz biçimde dışa aktarmak için seçeneklerden birini kullanın



Okoro, R.N., & Idris, A. (2022). The drug burden index medication use in older people in north-east Nigeria. İstanbul Journal of Pharmacy, 52(3), 332-341.


Okoro R N, Idris A. The drug burden index medication use in older people in north-east Nigeria. İstanbul Journal of Pharmacy. 2022;52(3):332-341.


Okoro, R.N.; Idris, A. The drug burden index medication use in older people in north-east Nigeria. İstanbul Journal of Pharmacy, [Publisher Location], v. 52, n. 3, p. 332-341, 2022.

Chicago: Author-Date Style

Okoro, Roland Nnaemeka, and Algoni Idris. 2022. “The drug burden index medication use in older people in north-east Nigeria.” İstanbul Journal of Pharmacy 52, no. 3: 332-341.

Chicago: Humanities Style

Okoro, Roland Nnaemeka, and Algoni Idris. The drug burden index medication use in older people in north-east Nigeria.” İstanbul Journal of Pharmacy 52, no. 3 (Jun. 2023): 332-341.

Harvard: Australian Style

Okoro, RN & Idris, A 2022, 'The drug burden index medication use in older people in north-east Nigeria', İstanbul Journal of Pharmacy, vol. 52, no. 3, pp. 332-341, viewed 9 Jun. 2023,

Harvard: Author-Date Style

Okoro, R.N. and Idris, A. (2022) ‘The drug burden index medication use in older people in north-east Nigeria’, İstanbul Journal of Pharmacy, 52(3), pp. 332-341. (9 Jun. 2023).


Okoro, Roland Nnaemeka, and Algoni Idris. The drug burden index medication use in older people in north-east Nigeria.” İstanbul Journal of Pharmacy, vol. 52, no. 3, 2022, pp. 332-341. [Database Container],


Okoro RN, Idris A. The drug burden index medication use in older people in north-east Nigeria. İstanbul Journal of Pharmacy [Internet]. 9 Jun. 2023 [cited 9 Jun. 2023];52(3):332-341. Available from: doi: 10.26650/IstanbulJPharm.2022.1139776


Okoro, RolandNnaemeka - Idris, Algoni. The drug burden index medication use in older people in north-east Nigeria”. İstanbul Journal of Pharmacy 52/3 (Jun. 2023): 332-341.


Çevrimiçi Yayınlanma30.12.2022


Attribution-NonCommercial (CC BY-NC)

This license lets others remix, tweak, and build upon your work non-commercially, and although their new works must also acknowledge you and be non-commercial, they don’t have to license their derivative works on the same terms.


İstanbul Üniversitesi Yayınları, uluslararası yayıncılık standartları ve etiğine uygun olarak, yüksek kalitede bilimsel dergi ve kitapların yayınlanmasıyla giderek artan bilimsel bilginin yayılmasına katkıda bulunmayı amaçlamaktadır. İstanbul Üniversitesi Yayınları açık erişimli, ticari olmayan, bilimsel yayıncılığı takip etmektedir.