Use of anticholinergic and sedative medications is potentially inappropriate in older adults due to associated adverse effects, including impaired cognitive and physical function. This study evaluated anticholinergic and sedative burden in Croatian community-dwelling older adults using the Drug Burden Index (DBI) and examined its association with self-reported health and healthcare utilization over 12 months. This observational, cross-sectional study, part of the EuroAgeism H2020 ESR 7 project, included conveniently sampled adults ≥ 65 years from community pharmacies in three Croatian regions. Data were collected using a standardized research questionnaire. DBI was used to quantify exposure to anticholinergic and sedative medications. Multivariate regression analyses examined associations between DBI and health outcomes, using logistic regression for binary outcomes and linear regression for self-reported health. Among 388 participants (63.7% female, median age 73), most had multimorbidity (median five diagnoses) and polypharmacy (63.9%), while 57% used at least one DBI medication-most commonly diazepam (15.5%) and tramadol (14.7%). High DBI (≥1) independently predicted more emergency department (ED) visits (OR = 2.45) and worse self-rated health (B = -0.26), but not hospitalization. High DBI in older adults was associated with more ED visits and poorer self-rated health, highlighting the need for targeted interventions to reduce anticholinergic and sedative use in this vulnerable population.

City Pharmacy Zagreb 10000 Zagreb Croatia

Department of Biomaterials and Biotechnology University Medical Center Groningen 9713 AV Groningen The Netherlands

Department of Internal Medicine and Geriatrics 1st Faculty of Medicine Prague Charles University 12108 Prague Czech Republic

Department of Social and Clinical Pharmacy Faculty of Pharmacy in Hradec Králové Charles University 500 03 Hradec Králové Czech Republic

Department of Social Pharmacy and Pharmaceutical Legislation Faculty of Pharmacy University of Belgrade 11221 Belgrade Serbia

Faculty of Pharmacy and Biochemistry University of Zagreb 10000 Zagreb Croatia

University Department of Psychology Catholic University of Croatia 10000 Zagreb Croatia

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