{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T06:30:46Z","timestamp":1789540246893,"version":"build-2803163510"},"reference-count":61,"publisher":"BMJ","issue":"7","funder":[{"DOI":"10.13039\/501100001590","name":"Health Research Board","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001590","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,6,7]]},"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>The Drug Burden Index (DBI) tool quantifies individual exposure to anticholinergic and sedative medications. The DBI has been internationally validated against adverse health outcomes in older people. DBI exposure has not been reported in the Irish older population. This study aimed to: (1) develop a list of drugs with clinically significant anticholinergic and\/or sedative effects (DBI medications) relevant to Ireland; (2) examine, using the DBI formula, the prevalence of exposure to DBI medications in Irish older people and (3) explore patient factors associated DBI exposure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A cross-sectional national pharmacy claims database study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Community setting using the General Medical Services (GMS) scheme pharmacy claims database maintained by the Health Service Executive Primary Care Reimbursement Services.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>Irish older individuals (aged \u226565 years) enrolled in the GMS scheme and dispensed at least one prescription item in 2016 (n=428\u2009516).<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Prevalence of exposure to DBI medications and patient factors associated with DBI exposure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>282\u2009874 (66%) of the GMS population aged \u226565 years were exposed to at least one DBI medication in 2016. Prevalence of exposure to DBI medications was significantly higher in females than males (females 71.6% vs males 58.7%, adjusted OR 1.65, 95%\u2009CI 1.63 to 1.68). Prevalence of DBI exposure increased progressively with the number of chronic drugs used, rising from 42.7% of those prescribed 0\u20134 chronic drugs to 95.4% of those on \u226512\u2009chronic drugs (adjusted OR 27.8, 95%\u2009CI 26.7 to 29.0). The most frequently used DBI medications were codeine\/paracetamol combination products (20.1% of patients), tramadol (11.5%), zopiclone (9.5%), zolpidem (8.5%), pregabalin (7.9%) and alprazolam (7.8%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The majority of older people in Ireland are exposed to medications with anticholinergic and\/or sedative effects, particularly females and those with multiple comorbidities. The high use of low-dose codeine\/paracetamol combination products, Z-drugs and benzodiazepines, suggests there are opportunities for deprescribing.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2018-022500","type":"journal-article","created":{"date-parts":[[2018,7,7]],"date-time":"2018-07-07T07:02:16Z","timestamp":1530946936000},"page":"e022500","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":62,"title":["Anticholinergic and sedative drug burden in community-dwelling older people: a national database study"],"prefix":"10.1136","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3306-6375","authenticated-orcid":false,"given":"Catherine J","family":"Byrne","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Walsh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitriona","family":"Cahir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Crist\u00edn","family":"Ryan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J","family":"Williams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Bennett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,7,6]]},"reference":[{"key":"2024051713125597000_8.7.e022500.1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/aft199"},{"key":"2024051713125597000_8.7.e022500.2","doi-asserted-by":"crossref","first-page":"1503","DOI":"10.2147\/CIA.S66660","article-title":"Drug Burden Index in older adults: theoretical and practical issues","volume":"9","author":"Kouladjian","year":"2014","journal-title":"Clin Interv Aging"},{"key":"2024051713125597000_8.7.e022500.3","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2008.02009.x"},{"key":"2024051713125597000_8.7.e022500.4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2011.03491.x"},{"key":"2024051713125597000_8.7.e022500.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjopharm.2010.10.004"},{"key":"2024051713125597000_8.7.e022500.6","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1111\/j.1532-5415.1997.tb05167.x","article-title":"Effect of a single dose of diazepam on balance measures in older people","volume":"45","author":"Cutson","year":"1997","journal-title":"J Am Geriatr Soc"},{"key":"2024051713125597000_8.7.e022500.7","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2125.2009.03411.x"},{"key":"2024051713125597000_8.7.e022500.8","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198812293192604"},{"key":"2024051713125597000_8.7.e022500.9","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/60.5.622"},{"key":"2024051713125597000_8.7.e022500.10","doi-asserted-by":"publisher","DOI":"10.1038\/sj.clpt.6100035"},{"key":"2024051713125597000_8.7.e022500.11","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2005.00571.x"},{"key":"2024051713125597000_8.7.e022500.12","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2009.229"},{"key":"2024051713125597000_8.7.e022500.13","doi-asserted-by":"publisher","DOI":"10.1016\/S0009-9236(98)90059-5"},{"key":"2024051713125597000_8.7.e022500.14","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38623.768588.47"},{"key":"2024051713125597000_8.7.e022500.15","doi-asserted-by":"publisher","DOI":"10.1002\/pds.3624"},{"key":"2024051713125597000_8.7.e022500.16","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.1999.tb03843.x"},{"key":"2024051713125597000_8.7.e022500.17","doi-asserted-by":"publisher","DOI":"10.2165\/00023210-200317110-00004"},{"key":"2024051713125597000_8.7.e022500.18","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2010.355"},{"key":"2024051713125597000_8.7.e022500.19","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.167.8.781"},{"key":"2024051713125597000_8.7.e022500.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2009.02.021"},{"key":"2024051713125597000_8.7.e022500.21","doi-asserted-by":"publisher","DOI":"10.1038\/clpt.2011.258"},{"key":"2024051713125597000_8.7.e022500.22","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2011.03386.x"},{"key":"2024051713125597000_8.7.e022500.23","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0083224","article-title":"Impact of high risk drug use on hospitalization and mortality in older people with and without Alzheimer\u2019s disease: a national population cohort study","volume":"9","author":"Gnjidic","year":"2014","journal-title":"PLoS One"},{"key":"2024051713125597000_8.7.e022500.24","unstructured":"Health Service Executive. 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