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The Drug Burden Index (DBI) is associated with poorer physical function in stable, community-dwelling, older people. The authors speculated that a higher DBI is associated with reduced physical function (Barthel Index, primary outcome) and predicts adverse outcomes (length of stay, in-hospital mortality, secondary outcomes) in frail, acutely ill, older hospitalized patients. Clinical and demographic characteristics, Barthel Index, DBI, and full medication exposure were recorded on admission in 362 consecutive patients (84 ± 7 years old) admitted to 2 acute geriatric units between February 1, 2010, and June 30, 2010. A unit increase in DBI was associated with a 29% reduction in the odds of being in a higher Barthel Index quartile than a lower quartile (odds ratio, 0.71; 95% confidence interval, 0.55-0.91; P = .007). The Barthel Index components mostly affected were bathing (P < .001), grooming (P < .001), dressing (P = .001), bladder function (P < .001), transfers (P = .001), mobility (P < .001), and stairs (P < .001). A higher DBI independently predicted length of stay (hazard ratio, 1.23; 95% confidence interval, 1.06-1.42; P = .005) but not in-hospital mortality (hazard ratio, 1.17; 95% confidence interval, 0.72-1.90; P = .52). Higher DBI scores on admission are independently associated with lower scores of the Barthel Index and predict length of stay among older hospitalized patients. The DBI may be useful in the acute setting to improve risk stratification.

Objectives: The anticholinergic risk scale (ARS) score is associated with the number of anticholinergic side effects in older outpatients. We tested the hypothesis that high ARS scores are negatively associated with “global” parameters of physical function (Barthel Index, primary outcome) and predict length of stay and in-hospital mortality (secondary outcomes) in older hospitalized patients. Design and Setting: Prospective study in 2 acute geriatric units. Participants: Three hundred sixty-two consecutive patients (age 83.6 ± 6.6 years) admitted between February 1, 2010, and June 30, 2010. Measurements: Clinical and demographic characteristics, Barthel Index, full medication exposure, and ARS score were recorded on admission. Data on length of stay and in-hospital mortality were obtained from electronic records. Results: After adjustment for age, gender, dementia, institutionalization, Charlson Comorbidity Index, admission site, and number of nonanticholinergic drugs, a unit increase in ARS score was associated with a 29% reduction in the odds of being in a higher Barthel quartile than a lower quartile (odds ratio 0.71, 95% confidence interval [CI] 0.59–0.86, P = .001). The Barthel components mostly affected were bathing (P < .001), grooming (P < .001), dressing (P < .001), transfers (P =.005), mobility (P < .001), and stairs (P < .001). Higher ARS scores predicted in-hospital mortality among patients with hyponatremia (hazard ratio [HR] 3.66, 95% CI 1.70–7.89, P = .001) but not those without hyponatremia (HR 1.04, 95% CI 0.70–1.54, P = .86). The ARS score did not significantly predict length of stay (HR 1.02, 95% CI 0.88–1.17, P = .82). Conclusion: High ARS scores are negatively associated with various components of the Barthel Index and predict in-hospital mortality in the presence of hyponatremia among older patients. The ARS score may be useful in the acute setting to improve risk stratification. [Copyright &y& Elsevier]