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Adverse drug reactions in older people

Part of: Bespoke shallow archive Weizmann

Published online by Cambridge University Press:  14 June 2010

B Tangiisuran ,
MP Gozzoli ,
JG Davies  and
C Rajkumar
B Tangiisuran*
Affiliation:
Department of Medicine, Brighton and Sussex Medical School, UK
MP Gozzoli
Affiliation:
Borgo Trento Verona Hospital, Italy
JG Davies
Affiliation:
Pharmaceutical Science Division, King's College London, UK
C Rajkumar
Affiliation:
Department of Medicine, Brighton and Sussex Medical School, UK
*
Address for correspondence: Dr Balamurugan Tangiisuran, Department of Medicine, Brighton and Sussex Medical School, University of Sussex, Falmer, UK. Email: [email protected]
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Summary

Adverse drug reactions (ADR) pose significant health-related problems for the older person. Many studies from around the world report a significant incidence of ADR in general and in elderly people in particular, resulting in an increase in drug-related morbidity and mortality. Older people appear to be particularly at risk of experiencing an ADR due to a range of factors, which include polypharmacy, altered drug pharmacokinetic profiles and pharmacodynamic responses, drug interactions and cognitive problems that increase the risk in this patient group. Certain drug classes, such as hypoglycaemic agents and cardiovascular active medicines, have been identified as common causes of ADR. Many studies suggest that the majority of ADR are preventable, so that several different approaches have been tried in an attempt to limit this problem, such as the use of computerized systems to communicate routine issues of patient care, interventions made by pharmacists, spontaneous reporting and continuous education of health care professionals. Whilst all have been shown to reduce drug-related events, identifying individuals at high risk of developing ADR at the point of prescribing by using a risk stratification model could improve the identification and prevention of ADR. This article discusses the clinical impact of ADR in older people and the relative merits of the various approaches tested to date before suggesting areas that require further research.

Keywords

adverse drug reactionsolder peopleadverse drug eventsdrug prescribingadverse event
Type
Psychological & social gerontology
Information
Reviews in Clinical Gerontology , Volume 20 , Issue 3 , August 2010 , pp. 246 - 259
Copyright
Copyright © Cambridge University Press 2010

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References

1McBride, WG.Thalidomide and congenital abnormalities. Lancet 1961; ii: 1358.CrossRefGoogle Scholar
2Lenaghan, E, Holland, R, Brooks, A. Home-based medication review in a high risk elderly population in primary care – the POLYMED randomised controlled trial. Age Ageing 2007; 36: 292–97.CrossRefGoogle Scholar
3Lowe, CJ, Raynor, DK, Purvis, J, Farrin, A, Hudson, J. Effects of a medicine review and education programme for older people in general practice. Br J Clin Pharmacol 2000; 50: 172–75.Google Scholar
4Bates, DW, Cullen, DJ, Laird, N, Petersen, LA, Small, SD, Servi, D et al. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. JAMA 1995; 274: 29–34.CrossRefGoogle ScholarPubMed
5Nebeker, JR, Barach, P, Samore, MH. Clarifying adverse drug events: a clinician's guide to terminology, documentation, and reporting. Ann Intern Med 2004; 140: 795–801.CrossRefGoogle ScholarPubMed
6World Health Organisation. International Drug Monitoring: The role of the hospital. WHO Tech Rep Ser 1969.Google Scholar
7Edwards, IR, Aronson, JK. Adverse drug reactions: definitions, diagnosis and management. Lancet 2000; 356: 1255–59.CrossRefGoogle ScholarPubMed
8Davies, EC, Green, CF, Taylor, S, Williamson, PR, Mottram, DR, Pirmohamed, M. Adverse drug reactions in hospital in-patients: a prospective analysis of 3695 patient-episodes. PLoS ONE 2009; 4: e4439.Google Scholar
9Davies, EC, Green, CF, Mottram, DR, Pirmohamed, M. Adverse drug reactions in hospital in-patients: a pilot study. J Clin Pharm Ther 2006; 31: 335–41.Google Scholar
10Pirmohamed, M, James, S, Meakin, S, Green, C, Scott, AK, Walley, TJ et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18,820 patients. BMJ 2004; 329: 15–19.Google Scholar
11Rawlins, MD, Thompson, JW. Pathogenesis of adverse drug reactions. In Textbooks of Adverse Drug Reactions (ed Davies, DM). Oxford, Oxford University Press, 1977.Google Scholar
12Aronson, JK, Ferner, RE. Joining the DoTS: new approach to classifying adverse drug reactions. BMJ 2003; 327: 1222–25.Google Scholar
13Rommers, MK, Teepe-Twiss, IM, Guchelaar, HJ. Preventing adverse drug events in hospital practice: an overview. Pharmacoepidemiol Drug Safety 2007; 16: 1129–35.Google Scholar
14Leape, LL, Brennan, TA, Laird, N, Lawthers, AG, Localio, AR, Barnes, BA et al. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. NEJM 1991; 324: 377–84.Google Scholar
15Wiffen, P, Gill, M, Edwards, J, Moore, A. Adverse drug reactions in hospital patients. A systematic review of the prospective and retrospective studies. Bandolier Extra Evidence-Based Health Care. 2002 (June): pp. 1–15.Google Scholar
16Beijer, HJ, de Blaey, CJ. Hospitalisations caused by adverse drug reactions (ADR): a meta-analysis of observational studies. Pharm World Sci 2002; 24: 46–54.CrossRefGoogle ScholarPubMed
17Gurwitz, JH, Field, TS, Harrold, LR, Rothschild, J, Debellis, K, Seger, AC et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA 2003; 289: 1107–16.CrossRefGoogle ScholarPubMed
18Azad, N, Tierney, M, Victor, G, Kumar, P. Adverse drug events in the elderly population admitted to a tertiary care hospital. J Healthcare Management/American College of Healthcare Executives 2002; 47: 295–305; discussion.Google Scholar
19Chan, M, Nicklason, F, Vial, JH. Adverse drug events as a cause of hospital admission in the elderly. Int Med J 2001; 31: 199–205.Google Scholar
20Hallas, J, Haghfelt, T, Gram, LF, Grodum, E, Damsbo, N. Drug related admissions to a cardiology department; frequency and avoidability. J Int Med 1990; 228: 379–84.CrossRefGoogle ScholarPubMed
21Cunningham, G, Dodd, TRP, Grant, DJ, McMurdo, MET, Michael, R, Richards, E. Drug-related problems in elderly patients admitted to Tayside hospitals, methods for prevention and subsequent reassessment. Age Ageing 1997; 26: 375–82.CrossRefGoogle ScholarPubMed
22Dartnell, JG, Anderson, RP, Chohan, V, Galbraith, KJ, Lyon, ME, Nestor, PJ et al. Hospitalisation for adverse events related to drug therapy: incidence, avoidability and costs. Med J Aust 1996; 164: 659–62.CrossRefGoogle ScholarPubMed
23Courtman, BJ, Stallings, SB. Characterization of drug-related problems in elderly patients on admission to a medical ward. Can J Hosp Pharm 1995; 48: 161–66.Google Scholar
24Page, RL 2nd, Ruscin, JM. The risk of adverse drug events and hospital-related morbidity and mortality among older adults with potentially inappropriate medication use. Am J Geriatr Pharmcother 2006; 4: 297–305.Google Scholar
25Gray, SL, Sager, M, Lestico, MR, Jalaluddin, M. Adverse drug events in hospitalized elderly. J Gerontol 1998; 53: M59–63.Google Scholar
26Davies, EC, Green, CF, Mottram, DR, Pirmohamed, M. Adverse drug reactions in hospitals: a narrative review. Current Drug Safety 2007; 2: 79–87.CrossRefGoogle ScholarPubMed
27Seidl, LG, Thornton, GF, Cluff, LE. Epidemiological studies of adverse drug reactions. Am J Pub Health 1965; 55: 1170–75.Google Scholar
28Hurwitz, N, Wade, OL. Intensive hospital monitoring of adverse reactions to drugs. BMJ 1969; 1: 531–36.Google Scholar
29Smith, CC, Bennett, PM, Pearce, HM, Harrison, PI, Reynolds, DJ, Aronson, JK et al. Adverse drug reactions in a hospital general medical unit meriting notification to the Committee on Safety of Medicines. Br J Clin Pharmacol 1996; 42: 423–29.Google Scholar
30Simmons, C, Georgeson, EM, Hill, RC. Adverse drug reactions: Can we reduce the risk? Hosp Pharm 1998; 33: 1568–76.Google Scholar
31van Kraaij, DJ, Haagsma, CJ, Go, IH, Gribnau, FW. Drug use and adverse drug reactions in 105 elderly patients admitted to a general medical ward. Netherland J Med 1994; 44: 166–73.Google Scholar
32Hohl, CM, Dankoff, J, Colacone, A, Afilalo, M. Polypharmacy, adverse drug-related events, and potential adverse drug interactions in elderly patients presenting to an emergency department. Ann Emerg Med 2001; 38: 666–71.Google Scholar
33Lindley, CM, Tully, MP, Paramsothy, V, Tallis, RC. Inappropriate medication is a major cause of adverse drug reactions in elderly patients. Age Ageing 1992; 21: 294–300.Google Scholar
34Mannesse, CK, Derkx, FH, de Ridder, MA, Man in't Veld, AJ, Van Der Cammen, TJ. Adverse drug reactions in elderly patients as a contributing factor for hospital admission: cross sectional study. BMJ 1997; 315: 1057–58.CrossRefGoogle ScholarPubMed
35Lazarou, J, Pomeranz, BH, Corey, PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA 1998; 279: 1200–5.Google Scholar
36Wester, K, Jonsson, AK, Spigset, O, Druid, H, Hagg, S. Incidence of fatal adverse drug reactions: a population based study. Br J Clin Pharmacol 2008; 65: 573–79.Google Scholar
37Department of Health. Audit Commission: A Spoonful of Sugar; Medicines management in NHS hospitals. London: Audit Commission, Department of Health; 2001.Google Scholar
38Buajordet, I, Ebbesen, J, Erikssen, J, Brors, O, Hilberg, T. Fatal adverse drug events: the paradox of drug treatment. J Int Med 2001; 250: 327–41.Google Scholar
39Classen, DC, Pestotnik, SL, Evans, RS, Lloyd, JF, Burke, JP. Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality. JAMA 1997; 277: 30–36.Google Scholar
40Bates, DW, Spell, N, Cullen, DJ, Burdick, E, Laird, N, Petersen, LA et al. The costs of adverse drug events in hospitalized patients. Adverse Drug Events Prevention Study Group. JAMA 1997; 277: 307–11.Google Scholar
41Rothschild, JM, Federico, FA, Gandhi, TK, Kaushal, R, Williams, DH, Bates, DW. Analysis of medication-related malpractice claims: causes, preventability, and costs. Arch Int Med 2002; 162: 2414–20.CrossRefGoogle ScholarPubMed
42El Desoky, ES. Pharmacokinetic-pharmacodynamic crisis in the elderly. Am J Ther 2007; 14: 488–98.Google Scholar
43Tangiisuran, B, Wright, J, Van Der Cammen, T, Rajkumar, C. Adverse drug reactions in elderly: challenges in identification and improving preventative strategies. Age Ageing 2009; 38: 358–59.Google Scholar
44Mangoni, AA, Jackson, SHD. Age-related changes in pharmacokinetics and pharmacodynamics: Basic principles and practical applications. Br J Clin Pharmacol 2003; 57: 6–14.Google Scholar
45Mannesse, CK, Van Der Cammen, TJ. [Adverse drug reactions in three older patients, even without changes in medication]. Nederlands tijdschrift voor geneeskunde 2003; 147: 585–87.Google ScholarPubMed
46Zeeh, J, Platt, D. The aging liver: structural and functional changes and their consequences for drug treatment in old age. Gerontology 2002; 48: 121–27.Google Scholar
47Wang, L. Changes in pharmacokinetics in the elderly and therapeutic drug monitoring of antiarrhythmic drugs. Life Sci J 2007; 4: 1–7.Google Scholar
48Department of Health. National Service Framework for Older People. London: Department of Health; 2001.Google Scholar
49Field, TS, Gurwitz, JH, Avorn, J, McCormick, D, Jain, S, Eckler, M et al. Risk factors for adverse drug events among nursing home residents. Arch Int Med 2001; 161: 1629–34.CrossRefGoogle ScholarPubMed
50Nguyen, JK, Fouts, MM, Kotabe, SE, Lo, E. Polypharmacy as a risk factor for adverse drug reactions in geriatric nursing home residents. Am J Geriatr Pharmacother 2006; 4: 36–41.Google Scholar
51Veehof, LJ, Stewart, RE, Meyboom-de Jong, B, Haaijer-Ruskamp, FM. Adverse drug reactions and polypharmacy in the elderly in general practice. Eur J Clin Pharmacol 1999; 55: 533–36.CrossRefGoogle ScholarPubMed
52Onder, G, Pedone, C, Landi, F, Cesari, M, Della Vedova, C, Bernabei, R et al. Adverse drug reactions as cause of hospital admissions: results from the Italian Group of Pharmacoepidemiology in the Elderly (GIFA). JAGS 2002; 50: 1962–68.Google Scholar
53Zopf, Y, Rabe, C, Neubert, A, Hahn, EG, Dormann, H. Risk factors associated with adverse drug reactions following hospital admission: a prospective analysis of 907 patients in two German university hospitals. Drug Saf 2008; 31: 789–98.Google Scholar
54van den Bemt, PM, Egberts, AC, Lenderink, AW, Verzijl, JM, Simons, KA, van der Pol, WS et al. Risk factors for the development of adverse drug events in hospitalized patients. Pharm World Sci 2000; 22: 62–66.CrossRefGoogle ScholarPubMed
55Leendertse, AJ, Egberts, AC, Stoker, LJ, van den Bemt, PM. Frequency of and risk factors for preventable medication-related hospital admissions in the Netherlands. Arch Int Med 2008; 168: 1890–96.Google Scholar
56Campbell, SE, Seymour, DG, Primrose, WR. A systematic literature review of factors affecting outcome in older medical patients admitted to hospital. Age Ageing 2004; 33: 110–15.CrossRefGoogle ScholarPubMed
57Kennerfalk, A, Ruigomez, A, Wallander, MA, Wilhelmsen, L, Johansson, S. Geriatric drug therapy and healthcare utilization in the United kingdom. Ann Pharmacother 2002; 36: 797–803.Google Scholar
58Beckett, NS, Peters, R, Fletcher, AE, Staessen, JA, Liu, L, Dumitrascu, D et al. Treatment of hypertension in patients 80 years of age or older. NEJM 2008; 358: 1887–98.Google Scholar
59Juurlink, DN, Mamdani, M, Kopp, A, Laupacis, A, Redelmeier, DA. Drug–drug interactions among elderly patients hospitalized for drug toxicity. JAMA 2003; 289: 1652–58.CrossRefGoogle ScholarPubMed
60Juurlink, DN, Mamdani, MM, Kopp, A, Rochon, PA, Shulman, KI, Redelmeier, DA. Drug-induced lithium toxicity in the elderly: a population-based study. JAGS 2004; 52: 794–98.Google Scholar
61Holbrook, AM, Pereira, JA, Labiris, R, McDonald, H, Douketis, JD, Crowther, M et al. Systematic overview of warfarin and its drug and food interactions. Arch Int Med 2005; 165: 1095–106.CrossRefGoogle ScholarPubMed
62Rochon, PA, Gurwitz, JH. Optimising drug treatment for elderly people: the prescribing cascade. BMJ 1997; 315: 1096–99.Google Scholar
63Hamilton, HJ, Gallagher, PF, O'Mahony, D. Inappropriate prescribing and adverse drug events in older people. BMC Geriatr 2009; 9: 5.Google Scholar
64Hajjar, ER, Hanlon, JT, Sloane, RJ, Lindblad, CI, Pieper, CF, Ruby, CM et al. Unnecessary drug use in frail older people at hospital discharge. JAGS 2005; 53: 1518–23.Google Scholar
65Schneider, JK, Mion, LC, Frengley, JD. Adverse drug reactions in an elderly outpatient population. Am J Hosp Pharm 1992; 49: 90–96.Google Scholar
66McElnay, JC, McCallion, CR, Al-Deagi, F, Scott, MG. Development of a risk model for adverse drug events in the elderly. Clin Drug Invest 1997; 13: 47–55.CrossRefGoogle Scholar
67Bowman, L, Carlstedt, BC, Hancock, EF, Black, CD. Adverse drug reaction (ADR) occurrence and evaluation in elderly inpatients. Pharmacoepidemiol Drug Safety 1996; 5: 9–18.3.0.CO;2-2>CrossRefGoogle ScholarPubMed
68Vakil, BJ, Kulkarni, RD, Chabria, NL, Chadha, DR, Deshpande, VA. Intense surveillance of adverse drug reactions. An analysis of 338 patients. J Clin Pharmacol 1975; 15: 435–41.Google Scholar
69Hajjar, ER, Hanlon, JT, Artz, MB, Lindblad, CI, Pieper, CF, Sloane, RJ et al. Adverse drug reaction risk factors in older outpatients. Am J Geriatr Pharmacol 2003; 1: 82–89.Google Scholar
70Green, JL, Hawley, JN, Rask, KJ. Is the number of prescribing physicians an independent risk factor for adverse drug events in an elderly outpatient population? Am J Geriatr Pharmacother 2007; 5: 31–39.Google Scholar
71Ganjavi, H, Herrmann, N, Rochon, PA, Sharma, P, Lee, M, Cassel, D et al. Adverse drug events in cognitively impaired elderly patients. Dem Geriatr Cog Disord 2007; 23: 395–400.Google Scholar
72Onder, G, Gambassi, G, Scales, CJ, Cesari, M, Vedova, CD, Landi, F et al. Adverse drug reactions and cognitive function among hospitalized older adults. Eur J Clin Pharmacol 2002; 58: 371–77.Google Scholar
73Hallas, J, Worm, J, Beck-Nielsen, J, Gram, LF, Grodum, E, Damsbo, N et al. Drug related events and drug utilization in patients admitted to a geriatric hospital department. Dan Med Bull 1991; 38: 417–20.Google Scholar
74Mannesse, CK, Derkx, FH, de Ridder, MA, Man in't Veld, AJ, Van Der Cammen, TJ. Do older hospital patients recognize adverse drug reactions? Age Ageing 2000; 29: 79–81.Google Scholar
75Howard, RL, Avery, AJ, Slavenburg, S, Royal, S, Pipe, G, Lucassen, P et al. Which drugs cause preventable admissions to hospital? A systematic review. Br J Clin Pharmacol 2007; 63: 136–47.Google Scholar
76Reason, J.Human error: models and management. BMJ 2000; 320: 768–70.Google Scholar
77Pham, CB, Dickman, RL. Minimizing adverse drug events in older patients. Am Fam Physician 2007; 76: 1837–44.Google Scholar
78Leape, LL, Bates, DW, Cullen, DJ, Cooper, J, Demonaco, HJ, Gallivan, T et al. Systems analysis of adverse drug events. ADE Prevention Study Group. JAMA 1995; 274: 35–43.Google Scholar
79Kaushal, R, Shojania, KG, Bates, DW. Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review. Arch Int Med 2003; 163: 1409–16.Google Scholar
80Bates, DW, Leape, LL, Cullen, DJ, Laird, N, Petersen, LA, Teich, JM et al. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA 1998; 280: 1311–16.Google Scholar
81Kucukarslan, SN, Peters, M, Mlynarek, M, Nafziger, DA. Pharmacists on rounding teams reduce preventable adverse drug events in hospital general medicine units. Arch Int Med 2003; 163: 2014–18.Google Scholar
82Holland, R, Desborough, J, Goodyer, L, Hall, S, Wright, D, Loke, YK. Does pharmacist-led medication review help to reduce hospital admissions and deaths in older people? A systematic review and meta-analysis. Br J Clin Pharmacol 2008; 65: 303–16.CrossRefGoogle ScholarPubMed
83Gillespie, U, Alassaad, A, Henrohn, D, Garmo, H, Hammarlund-Udenaes, M, Toss, H et al. A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: a randomized controlled trial. Arch Int Med 2009; 169: 894–900.Google Scholar
84Schmader, KE, Hanlon, JT, Pieper, CF, Sloane, R, Ruby, CM, Twersky, J et al. Effects of geriatric evaluation and management on adverse drug reactions and suboptimal prescribing in the frail elderly. Am J Med 2004; 116: 394–401.Google Scholar
85Andersohn, F, Suissa, S, Garbe, E. Use of first- and second-generation cyclooxygenase-2-selective non-steroidal antiinflammatory drugs and risk of acute myocardial infarction. Circulation 2006; 113: 1950–57.Google Scholar
86Ayers, CR, Sorrell, JT, Thorp, SR, Wetherell, JL. Evidence-based psychological treatments for late-life anxiety. Psychology Aging 2007; 22: 8–17.Google Scholar
87Meyer, UA. Pharmacogenetics and adverse drug reactions. Lancet 2000; 356: 1667–71.Google Scholar
88Ross, CJ, Katzov, H, Carleton, B, Hayden, MR. Pharmacogenomics and its implications for autoimmune disease. J Autoimmun 2007; 28: 122–28.Google Scholar
89Steyerberg, E. Clinical Prediction Models: A practical approach to development, validation, and updating. Gail, MKK, Samet, J, Tsiatis, A, Wong, W (eds). Rotterdam: Springer; 2009.Google Scholar
90Wasson, JH, Sox, HC, Neff, RK, Goldman, L. Clinical prediction rules. Applications and methodological standards. NEJM 1985; 313: 793–99.Google Scholar
91Johnston, PE, France, DJ, Byrne, DW, Murff, HJ, Lee, B, Stiles, RA et al. Assessment of adverse drug events among patients in a tertiary care medical center. Am J Health Syst Pharm 2006; 63: 2218–27.CrossRefGoogle Scholar
92Rask, KJ, Wells, KJ, Teitel, GS, Hawley, JN, Richards, C, Gazmararian, JA. Can an algorithm for appropriate prescribing predict adverse drug events? Am J Man Care 2005; 11: 145–51.Google Scholar
93Passarelli, MC, Jacob-Filho, W. Adverse drug reactions in elderly patients: how to predict them? Einstein 2007; 5: 246–51.Google Scholar
94Onder, G, Petrovic, M, Tangiisuran, B, Meinardi, MC, Markito-Notenboorn, WP, Somers, A et al. Development and validation of a score to assess risk of adverse drug reactions among inhospital patients aged 65 or older: The GerontoNet ADR risk score. Arch Int Med 2010 (in press).Google Scholar
95Elnicki, RA, Schmitt, JP. Contribution of patient and hospital characteristics to adverse patient incidents. Health Serv Res 1980; 15: 397–414.Google Scholar
96Kanjanarat, P, Winterstein, AG, Johns, TE, Hatton, RC, Gonzalez-Rothi, R, Segal, R. Nature of preventable adverse drug events in hospitals: a literature review. Am J Health Syst Pharm 2003; 60: 1750–59.Google Scholar