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

Year: 2026

Type: article

Abstract: Background Polypharmacy is linked to balance impairment and falls. Thus, pharmacological screening tools are essential for identifying high-risk patients. Objectives To investigate the association between medication burden, postural balance, and recent falls in community-dwelling older adults. Methods 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. Results 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 χ 2 = 5.91, p = 0.0001). ROC analysis of COP area resulted in an AUC of 0.75 (cut-off: 0.5; Accuracy: 72.9%). Conclusion 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.

Source: Frontiers in Medicine

DOI: 10.3389/fmed.2026.1678855