# Drug Burden Index and its association with postural balance and falls among community-dwelling older adults

## TL;DR

This study shows that higher medication burden in older adults is linked to worse balance and more falls, suggesting that tracking drug load can help identify those at risk.

## Contribution

The study demonstrates a dose-response relationship between Drug Burden Index and balance impairment, supporting its use as a screening tool.

## Key findings

- Higher Drug Burden Index (DBI) was strongly associated with worse postural balance and increased fall risk.
- A DBI cut-off of 0.5 effectively identified balance impairment in older adults.
- Female sex was protective against balance deficits in multivariable analysis.

## Abstract

Polypharmacy is linked to balance impairment and falls. Thus, pharmacological screening tools are essential for identifying high-risk patients.

To investigate the association between medication burden, postural balance, and recent falls in community-dwelling older adults.

This cross-sectional study included adults aged ≥ 60 years attending a university outpatient clinic in Brazil. Sociodemographic characteristics, comorbidities, medication use, handgrip strength, and recent fall were collected. Medication burden was classified as no, low, or high according to the Drug Burden Index. Postural balance was assessed using a standardized one-legged stance protocol on a BIOMEC 400-412 force platform, with Center of Pressure (COP) area and sway velocity as primary and recent falls as secondary outcomes.

This study included 170 participants, and no demographic differences were found across DBI categories. DBI was significantly associated with postural balance, with greater COP area and sway velocity among individuals with low or high burden (p < 0.0001). In multivariable analysis, female sex was protective against balance deficit (OR = 0.35, 95% CI: 0.15–0.78, p = 0.01), and DBI demonstrated a strong dose–response pattern (low: OR = 7.29; high: OR = 30.66). Higher DBI also correlated with recent falls (trend χ2 = 5.91, p = 0.0001). ROC analysis of COP area resulted in an AUC of 0.75 (cut-off: 0.5; Accuracy: 72.9%).

Higher DBI was associated with impaired balance and increased fall risk, with a 0.5 cut-off effectively identifying balance impairment and supporting DBI as a practical tool for detecting older adults at risk.