{"doi":"10.1002/pds.5144","title":"Quantifying cumulative anticholinergic and sedative drug load among <scp>US</scp> Medicare Beneficiaries","abstract":"PURPOSE: Medications with anticholinergic and sedative properties are widely used among older adults despite strong evidence of harm. The drug burden index (DBI), a pharmacological screening tool, measures these properties across drug classes, and higher DBI drug exposure (DBI > 1) has been associated with certain physical function-related adverse events. Our aim was to quantify mean daily DBI drug exposure among older adults in the United States (US). METHODS: We screened medications for DBI properties and operationalized the DBI for US Medicare claims. We then conducted a retrospective cohort study of a 20% random, nationwide sample of 4 137 384 fee-for-service Medicare beneficiaries aged 66+ years (134 757 039 person-months) from January 2013 to December 2016. We measured the monthly distribution based on mean daily DBI, categorized as (a) >0 vs 0 (any use) and (b) 0, 0 < DBI ≤ 1, 1 < DBI ≤ 2, and DBI > 2, and examined temporal trends. We described patient-level factors (eg, demographics, healthcare use) associated with high (>2) vs low (0 < DBI≤1) DBI drug exposure. RESULTS: The distribution of the mean daily DBI, aggregated at the month-level, was: 58.1% DBI = 0, 29.0% 0 < DBI≤1, 9.3% 1 < DBI≤2, and 3.7% DBI > 2. Predictors of high monthly DBI drug exposure (DBI > 2) included certain indicators of increased healthcare use (eg, high number of drug claims), white race, younger age, frailty, and a psychosis diagnosis code. CONCLUSIONS: The predictors of high DBI drug exposure can inform discussions between patients and providers about medication appropriateness and potential de-prescribing. Future Medicare-based studies should assess the association between the DBI and adverse events.","journal":"Pharmacoepidemiology and Drug Safety","year":2020,"id":83021,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":12,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9432,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":426826,"name":"Virginia Pate","orcid":"0000-0002-2141-8882","position":1,"is_corresponding":false},{"id":427885,"name":"Marc J. Pepin","orcid":"0000-0002-7560-4461","position":2,"is_corresponding":false},{"id":427886,"name":"Janine C. Bailey","orcid":"0000-0001-8845-2543","position":3,"is_corresponding":false},{"id":396956,"name":"Laura C. Hanson","orcid":"0000-0001-5120-6058","position":4,"is_corresponding":false},{"id":426828,"name":"Til Stürmer‎","orcid":"0000-0002-9204-7177","position":5,"is_corresponding":false},{"id":427887,"name":"Rebecca B. Naumann","orcid":"0000-0002-6648-0794","position":6,"is_corresponding":false},{"id":383773,"name":"Yvonne M. Golightly","orcid":"0000-0003-1205-2759","position":7,"is_corresponding":false},{"id":427888,"name":"Danijela Gnjidic","orcid":"0000-0002-9404-3401","position":8,"is_corresponding":false},{"id":387620,"name":"Jennifer L. Lund","orcid":"0000-0002-1108-0689","position":9,"is_corresponding":false},{"id":427884,"name":"Shahar Shmuel","orcid":"0000-0003-1726-1875","position":0,"is_corresponding":true}],"reference_count":52,"raw_metadata":null,"created_at":"2026-07-18T21:54:09.383533Z","pmid":"33000867","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}