Adverse Drug Reactions in an Elderly Hospitalised Population: Inappropriate Prescription is a Leading Cause (original) (raw)
Related papers
Adverse drug reactions in an elderly hospitalised population
Drugs & aging, 2005
problem in the aged. In order to better evaluate this problem in Brazil, this study was designed to assess the prevalence of ADRs in an elderly hospitalised population, identify the most common ADRs and the principal medications involved, evaluate the appropriateness of use of these drugs in elderly people and determine the risk factors implicated in the appearance of such ADRs. Methods: The study population was comprised of 186 elderly patients (≥60 years of age) admitted to the internal medicine service of a teaching hospital. The patients were assessed by a single observer using an intensive drug surveillance method to identify and report ADRs. The degree of probability for each adverse reaction was determined using the Naranjo algorithm. Results: The mean (± SD) age of the patients studied was 73.6 ± 9.1 years. Up to 115 patients (61.8%) of the study population presented at least one ADR. A total of 199 ADRs were found, at an average of 1.7 per patient. The ADRs appeared during hospitalisation in 46.2% of the study population, were present at the time of the admission but did not cause hospitalisation in 17.2% of patients, and were the cause of admission in 11.3% of patients. The most frequent ADR that caused hospitalisation was digitalis toxicity (22.7% of such ADRs). Hypokalaemia as a result of diuretics was the most prevalent ADR both during hospitalisation (11.8%) and at the time of admission without being the cause (12.1%). Captopril was the most frequently prescribed drug (138 prescriptions), and led to an ADR in 18.1% of patients who received the drug. Almost a quarter of the patients presenting an ADR were prescribed drugs considered inappropriate for the elderly. By means of a multiple logistic regression model, the following were considered to be significant risk factors for the appearance of ADRs: number of diagnoses (odds ratio [OR] 1.40; 95% CI 1.06, 1.86), number of drugs (OR 1.07; 95% CI 1.01, 1.13) and use of drug that is inappropriate for the elderly (OR 2.32; 95% CI 1.17, 4.59).
Biomedical and Pharmacology Journal, 2017
Adverse drug reactions [ADRs] are more frequently encountered in the elderly (> 60 years) population. The etiology is multifactorial and often interconnected with interplay of many factors like polypharmacy, altered drug pharmacokinetic and pharmacodynamics responses, drug interactions that increase their risk for ADR, making them a vulnerable population. Hence, the present study was taken up. Objective: • To evaluate clinical pattern, causality, severity and preventability of ADR's in the elderly population. • To evaluate Potentially inappropriate medicines [PIM] leading to ADRs using Beer's criteria. An observational study was conducted from 2011 to 2015 to analyze ADRs in elderly reported from Victoria hospital attached to BMC&RI. Relevant data on patient's demographics, details of ADR's, causal drug details, outcome were collected as per CDSCO ADR reporting form. Causality was assessed using WHO causality assessment scale, severity using modified Hartwig and Siegel severity scale and preventability by modified Thornton and Schumock scale. Potentially inappropriate medicines (PIM) were determined according to Beer's criteria. A total of 89 ADRs were reported during the study period, out of which 11% were reported in elderly. Majority (86%) were noted in the age group of 60-70 years. Dermatological (34%) followed by GIT (24%) system was predominantly affected due to ADR's. Maculopapular rash (29.21%) was the most common ADR followed by gastritis (7.86%) and diarrhea (5.61%). Major contribution to the ADR's was from J01cephalosporins (22.5%), N02 NSAID's (20.22%) and J05 antiviral (6.7%) of the ATC groups. 87.6% of the ADR's were probable and 12.4% were possible on WHO causality scale. Most ADRs were mild (51.68%) and moderate (44.94%). Majority were type A (98.87%) ADRs and probably preventable (92.1%). According to Beer's criteria 30.33% of drugs causing ADR were PIM with NSAID's (20.22%) being the most common inappropriately prescribed drugs. Most of the ADRs in elderly are predictable and preventable and are caused by commonly prescribed drugs like antibacterial and analgesics. Nearly one fourth of the ADRs were due to PIM which can be minimized by careful application of Beer's criteria.
Adverse drug reactions in older patients: an Italian observational prospective hospital study
Drug, Healthcare and Patient Safety, 2012
Background: In adults over 65 years of age, the frequency of adverse drug reaction (ADRs) related hospital admissions is higher than in younger adults, and the frequency of ADRs occurring during hospital stay highly ranges. The review was designed to evaluate the frequency of ADRs, both resulting in hospital admission and occurring during the hospital stay of older patients, while identifying the types of reactions and the associated drugs. Methods: Age, sex, date, and diagnosis of admission of all patients aged 65 and over admitted in three geriatric wards of University Hospital of Verona, Italy, from February to July 2009 were registered by nurses on a special form. In the specific cases of admissions caused by an ADR as well as in the cases of an ADR occurring during the hospital stay, the type of reactions and the suspected drugs were also registered by nurses and physicians involved in the study. Results: During the six months of the study, 1023 patients matched the inclusion criteria and were included in the study. One hundred fourteen hospital admissions (11.1%) were caused by ADRs, while 256 patients (25.0%) had an ADR during their hospital stay. The duration of hospital stay was significantly longer in patients who developed an ADR during their time in hospital, 18.7 (95% CI: 17.2-20.1) days versus 12.6 (95% CI: 11.9-13.3) days. Electrolyte disorders, gastrointestinal disorders, anemia, and International Normalized Ratio increase were the more frequent observed ADRs, with diuretics, antithrombotic agents, and antibacterials as the main involved drugs. Our study confirms that ADRs are an important cause of hospitalization in older patients. In addition, the frequency of ADRs occurring during hospital stay is high and causes prolonged hospitalization.
Journal of The American Geriatrics Society, 2002
Background: Adverse drug reactions (ADRs) are a significant cause of morbidity and mortality. Methods: A prospective study was conducted over a 6-month period. All patients consecutively admitted were enrolled in the study. Analysis included: (1) an evaluation of the frequency of ADR-related hospital admissions and their causality, severity, and preventability; (2) a description of the type of drugs involved; (3) a report of the most common clinical manifestations related to these ADRs; and (4) an assessment of the factors that were predictive of ADRs. Results: Seventy of the 548 admissions (12.8%) were related to an ADR. Hemorrhage represented the most common ADR (37.3%), followed by metabolic and renal events (10.8% each). The drugs most often involved were non-steroid anti-inflammatory drugs (NSAIDs), followed by diuretics, aspirin, oral anticoagulants, and oral hypoglycemic agents. A comparison between ADR and non-ADR-related admissions showed that mean number of medications and age were significantly higher for patients admitted for an ADR than for those who were not. Gender, chronic disease at admission, days of hospitalization, cognitive impairment, renal insufficiency, physical activity impairment, and use of psychoactive drugs did not differ between the two groups. In the multivariate analysis, number of drugs was the only independent predictor of ADR-related hospital admission (OR = 1.064, 95% CI 1.019-1.109). In 13 of 70 (18.6%) ADR-related hospital admissions, ADRs were coded as severe. Conclusions: ADRs are common causes of hospital admissions and may have important consequences. The most important determinant for ADR-related hospital admissions is the number of drugs taken.
Drugs & Therapy Perspectives, 2020
Background: Adverse Drug Reactions (ADRs) form one of the leading causes of morbidity and mortality particularly in the elderly population. Alterations in pharmacokinetics and pharmacodynamics with ageing results in increased ADRs which may be novel in respect to the young and may also vary from one older individual to another. These may hence be invaluable in personalized medicine. Objective: The primary objective of this pilot study was to find the occurrence of ADRs in north Indian elderly patients admitted in the Geriatric ward, to analyze its epidemiological attributes and to draw conclusions regarding its implications in designing individualized treatment regimens and plan for larger multi-centric studies. Methods: Elderly patients (>50 years age) admitted in the Geriatric ward were enrolled in this hospital-based, prospective observational study done during the period of September 2014 to September 2015 and June 2016 to October 2017. Adverse drug reaction data was collected based on self-reporting by patients or attendants and/or physician diagnosis. Results: Out of 658 patients (M=388; F=270) admitted in the geriatric ward, 149 ADRs were reported in 103 patients (22.6%). 28 patients (4.2 % of all patients) experienced more than one ADR. Polypharmacy was seen in 98% cases of ADRs. Most commonly reported individual ADR was hypokalemia (13.4%) followed by diarrhea (8.7%). Electrolyte and metabolic abnormalities were the most common ADRs (27.5%) followed by the involvement of gastrointestinal system (18%) and central nervous system (13.4%). 120 (80.5%) ADRs were dose related i.e. Type A ADR and 22 ADRs (14.8%) were immunologic or type B ADRs. In addition, there were 2 cases of ADRs due to drug withdrawal (type E). Category wise, antibiotics were involved in maximum (32.2 % of ADRs) cases followed by diuretics (11.4 % of ADRs), intravenous fluids (10% of ADRs) and antihypertensives (9.4% of ADRs). The Naranjo scale was not applicable in 12.75% of ADRs; mostly due to multiple drugs or interactions being suspected. 55% ADRs were of moderate severity while 11% ADRs were of severe category. ADRs were found to increase the hospital stay by an average of 2 days. Mortality was seen in 4 cases with ADRs. 63% of ADRs were avoidable. Conclusion: A higher than described incidence of ADRs was seen in our study. Polypharmacy was observed as a universal association. Antibiotics and diuretics were the common culprits. A greater fraction of ADRs is avoidable by proper vigilance and adequate monitoring. Awareness about the culprit drugs and associated regional variations may help in avoiding them in the older patients of specific ethnicities. The study highlights the incidence, severity and type of ADRs in the north Indian elderly population and gives platform for large-scale studies in future.
Journal of Postgraduate Medicine, 2011
Introduction Studies that evaluate the safety of non-prescription drugs in children remain scarce. Objectives The aim of the present study was to compare adverse drug reactions (ADRs) due to prescription versus non-prescription drugs in children. Methods We conducted a retrospective analysis of ADR notifications for a pediatric population (aged \18 years) registered in the French PharmacoVigilance Database (FPVD) between January 1985 and December 2016 by the Midi-Pyrénées PharmacoVigilance Center (in the south of France). We compared ADR profiles according to drug prescription status using a Chi-squared test. Results We included 2218 notifications concerning 3687 ADRs in the study. Non-prescription drugs were involved in 506 notifications (22.8%). Patients were younger in the non-prescription drug group (6.7 ± 5.3 vs. 8.4 ± 5.7 years in the prescription drug group). No difference by sex was found. Neurological ADRs were more frequent with prescription drugs (21.0%) than with non-prescription drugs (14.2%, p = 0.0008), whereas dermatological disorders (37.2 vs. 29.1%, respectively) and general ADRs (30.8 vs. 20.1%, respectively) were more frequent with non-prescription than with prescription drugs (p = 0.0006 and p \ 0.0001, respectively). The frequency of ''serious'' ADRs was higher with prescription drugs than with nonprescription drugs (40.9 vs. 34.2%, p = 0.007). The nonprescription drugs most frequently implicated with serious ADRs were ibuprofen (n = 37; 4.2%), tuberculosis vaccine (n = 23; 2.6%), aspirin (n = 20, 2.3%), and paracetamol (n = 17; 1.9%). ADRs from prescription drugs involved asparaginase (n = 27; 3.1%), immunoglobulins (n = 25; 2.9%), and amoxicillin (n = 23; 2.4%). Conclusions Non-prescription drugs, usually considered safe, were frequently responsible for ADR notifications. The non-prescription medication most frequently involved in serious ADRs was ibuprofen.
Journal of Pharmacy & Pharmaceutical Sciences, 2011
Purpose: Potentially Inappropriate Medications (PIM) use in elderly people may be responsible for the development of Adverse Drug Reaction (ADR) which, when severe, leads to hospital admissions. Objectives: to estimate the prevalence of elderly who had used PIM before being admitted to hospital admission and to identify the risk factors and the hospitalizations related to ADR arising from PIM. Methods: A descriptive and cross-sectional study was performed in the internal medicine ward of a teaching hospital (Brazil), in 2008. With the aid of a validated form, patients aged ≥ 60 years, with length of hospital stay ≥ 24 hours, were interviewed about drugs taken prior to the hospital admission and the complaints/reasons for hospitalization. Results: 19.1% (59/308) of older patients had taken PIM before hospital admission and in 4.9%; there were a causal relation between the PIM taken and the complaint reported. PIM responsible for admissions were: amiodarone, amitriptyline, cimetidine,...