Drug Burden Index Score and Anticholinergic Risk Scale as Predictors of Readmission to the Hospital

OBJECTIVE: Determine the association between different measures of drug exposure such as an increased Drug Burden Index (DBI) and a higher Anticholinergic Risk Scale (ARS) score in vulnerable elders and risk of readmission to the hospital. DESIGN: The study is a retrospective cohort comparing ARS and DBI between patients readmitted and not readmitted to the hospital within 30 days of initial admission. Data collected included drugs considered to have anticholinergic, sedative, or both types of properties (Appendix 1), medication strengths, doses per day, patient age, Vulnerable Elders Survey (VES-13) score upon admission, patient diagnoses, and rates of admission. SETTING: Nonprofit, 838-bed, regional health system of four hospitals. PATIENTS, PARTICIPANTS: Patients were included in the study if they were admitted to a hospital floor, were 65 years of age or older, were assessed using VES-13, and did not have routinely visiting family to engage them as observed by floor nurses. INTERVENTIONS: None; retrospective study. MAIN OUTCOME MEASURES: Readmission rate. RESULTS: The mean difference in DBI and ARS scores were higher in the readmitted group. Hydrocodone and hydroxyzine were the most commonly used drugs in the readmitted group that were considered when determining DBI. CONCLUSION: There is a role for screening and clinical intervention in vulnerable elders using DBI and ARS to help identify those at greatest risk for readmission to the hospital.