In-hospital adverse drug reactions in older adults; prevalence, presentation and associated drugs—a systematic review and meta-analysis

Abstract Background the prevalence of adverse drug reactions (ADRs) in hospitalised older patients, their clinical presentations, causative drugs, severity, preventability and measurable outcomes are unclear, ADRs being an increasing challenge to older patient safety. Methods we systematically searched PubMed, Embase, EBSCO-CINAHL, the Cochrane Library, ‘rey’ literature and relevant systematic review bibliographies, published from database inception to March 2020. We included any study reporting occurrence of in-hospital ADRs as primary or secondary outcomes in hospitalised older adults (mean age ≥ 65 years). Two authors independently extracted relevant information and appraised studies for bias. Study characteristics, ADR clinical presentations, causative drugs, severity, preventability and clinical outcomes were analysed. Study estimates were pooled using random-effects meta-analytic models. Results from 2,399 abstracts, we undertook full-text screening in 286, identifying 27 studies (29 papers). Final analysis yielded a pooled ADR prevalence of 16% (95%CI 12–22%, I2 98%,τ2 0.8585), in a population of 20,153 hospitalised patients aged ≥65 years of whom 2,479 patients experienced ≥ one ADR. ADR ascertainment was highly heterogeneous. Almost 48.3% of all ADRs involved five presentations: fluid/electrolyte disturbances (17.3%), gastrointestinal motility/defaecation disorders (13.3%), renal disorders (8.2%), hypotension/blood pressure dysregulation disorders/shock (5.5%) and delirium (4.1%). Four drug classes accounted for 57.8% of causative medications i.e. diuretics (19.8%), anti-bacterials (14.8%), antithrombotic agents (12.2%) and analgesics (10.9%). Pooled analysis of severity was not feasible. Four studies reported the majority of ADRs as preventable (55–95%). Conclusions on average, 16% of hospitalised older patients experience significant ADRs, varying in severity and mostly preventable, with commonly prescribed drug classes accounting for most ADRs.

Download Full-text

24In-Hospital Adverse Drug Reactions in Hospitalised Older Adults - A Systematic Review

Age and Ageing ◽

10.1093/ageing/afy140.14 ◽

2018 ◽

Vol 47 (suppl_5) ◽

pp. v13-v60 ◽

Cited By ~ 1

Author(s):

Emma Jennings ◽

Kevin Murphy ◽

Paul Gallagher ◽

Denis O’Mahony

Keyword(s):

Systematic Review ◽

Older Adults ◽

Adverse Drug Reactions ◽

Drug Reactions

Download Full-text

Prevalence of adverse drug events and adverse drug reactions in hospital among older patients with dementia: A systematic review

British Journal of Clinical Pharmacology ◽

10.1111/bcp.14417 ◽

2020 ◽

Author(s):

Marissa Anne Sakiris ◽

Mouna Sawan ◽

Sarah Nicole Hilmer ◽

Rebecca Awadalla ◽

Danijela Gnjidic

Keyword(s):

Systematic Review ◽

Adverse Drug Reactions ◽

Older Patients ◽

Adverse Drug Events ◽

Drug Reactions

Download Full-text

Predicting adverse drug reactions in older adults; a systematic review of the risk prediction models

Clinical Interventions in Aging ◽

10.2147/cia.s65475 ◽

2014 ◽

pp. 1581 ◽

Cited By ~ 31

Author(s):

Jennifer Stevenson ◽

Josceline L Williams ◽

Thomas G Burnham ◽

A Toby Prevost ◽

Rebekah Schiff ◽

...

Keyword(s):

Systematic Review ◽

Older Adults ◽

Risk Prediction ◽

Adverse Drug Reactions ◽

Prediction Models ◽

Drug Reactions ◽

Risk Prediction Models

Download Full-text

Drug-drug interactions and adverse drug reactions in polypharmacy among older adults: an integrative review

Revista Latino-Americana de Enfermagem ◽

10.1590/1518-8345.1316.2800 ◽

2016 ◽

Vol 24 (0) ◽

Cited By ~ 19

Author(s):

Maria Cristina Soares Rodrigues ◽

Cesar de Oliveira

Keyword(s):

Older Adults ◽

Drug Interactions ◽

Adverse Drug Reactions ◽

Inappropriate Prescribing ◽

Integrative Review ◽

Geriatric Nursing ◽

Drug Reactions ◽

Exclusion Criteria ◽

Drug Classes ◽

Negative Health Outcomes

ABSTRACT Objective: to identify and summarize studies examining both drug-drug interactions (DDI) and adverse drug reactions (ADR) in older adults polymedicated. Methods: an integrative review of studies published from January 2008 to December 2013, according to inclusion and exclusion criteria, in MEDLINE and EMBASE electronic databases were performed. Results: forty-seven full-text studies including 14,624,492 older adults (≥ 60 years) were analyzed: 24 (51.1%) concerning ADR, 14 (29.8%) DDI, and 9 studies (19.1%) investigating both DDI and ADR. We found a variety of methodological designs. The reviewed studies reinforced that polypharmacy is a multifactorial process, and predictors and inappropriate prescribing are associated with negative health outcomes, as increasing the frequency and types of ADRs and DDIs involving different drug classes, moreover, some studies show the most successful interventions to optimize prescribing. Conclusions: DDI and ADR among older adults continue to be a significant issue in the worldwide. The findings from the studies included in this integrative review, added to the previous reviews, can contribute to the improvement of advanced practices in geriatric nursing, to promote the safety of older patients in polypharmacy. However, more research is needed to elucidate gaps.

Download Full-text

Inappropriate Drug Prescribing in Older Adults: How to Reduce It?

European Journal of Case Reports in Internal Medicine ◽

10.12890/2015_s1sp01 ◽

2015 ◽

Vol 2 (6) ◽

Author(s):

Mirko Petrovich

Keyword(s):

Older Adults ◽

Adverse Drug Reactions ◽

Older Patients ◽

Inappropriate Drug ◽

Drug Prescribing ◽

Drug Related Problems ◽

Drug Reactions ◽

Critical Step ◽

Patients At Risk ◽

Geriatric Pharmacotherapy

Because older patients are more vulnerable to adverse drug-related events, there is a need to ensure appropriate pharmacotherapy in these patients. Screening to identify older patients at risk of drug-related problems (DRP) and adverse drug reactions (ADR) is the first critical step within a multistep approach to geriatric pharmacotherapy.

Download Full-text

Polypharmacy Adverse Drug Reactions (PADRe): Nurse-led Intervention to Minimise Adverse Drug Reactions for Older Adults in Care Homes: a Quality Improvement Process Intervention

Case Medical Research ◽

10.31525/ct1-nct03955133 ◽

2019 ◽

Author(s):

Keyword(s):

Older Adults ◽

Quality Improvement ◽

Adverse Drug Reactions ◽

Care Homes ◽

Drug Reactions ◽

Quality Improvement Process ◽

Improvement Process

Download Full-text

Adverse drug reactions of oral dexamethasone in children and adolescents with childhood acute lymphoblastic leukemia: a systematic review

The JBI Database of Systematic Reviews and Implementation Reports ◽

10.11124/01938924-201109110-00001 ◽

2011 ◽

Vol 9 (11) ◽

pp. 371-399

Author(s):

Loh Hu ◽

Ang Neo Kim Emily ◽

Yeoh Eng Juh Allen

Keyword(s):

Systematic Review ◽

Acute Lymphoblastic Leukemia ◽

Children And Adolescents ◽

Adverse Drug Reactions ◽

Lymphoblastic Leukemia ◽

Childhood Acute Lymphoblastic Leukemia ◽

Drug Reactions ◽

Oral Dexamethasone

Download Full-text

Clinical features and outcomes of COVID-19 in older adults: a systematic review and meta-analysis

BMC Geriatrics ◽

10.1186/s12877-021-02261-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sunny Singhal ◽

Pramod Kumar ◽

Sumitabh Singh ◽

Srishti Saha ◽

Aparajit Ballav Dey

Keyword(s):

Systematic Review ◽

Older Adults ◽

Critically Ill ◽

Clinical Features ◽

Older Patients ◽

Clinical Characteristics ◽

Meta Analysis ◽

Severe Infection ◽

Factors Affecting ◽

Pooled Prevalence

Abstract Background Few studies have focused on exploring the clinical characteristics and outcomes of COVID-19 in older patients. We conducted this systematic review and meta-analysis to have a better understanding of the clinical characteristics of older COVID-19 patients. Methods A systematic search of PubMed and Scopus was performed from December 2019 to May 3rd, 2020. Observational studies including older adults (age ≥ 60 years) with COVID-19 infection and reporting clinical characteristics or outcome were included. Primary outcome was assessing weighted pooled prevalence (WPP) of severity and outcomes. Secondary outcomes were clinical features including comorbidities and need of respiratory support. Result Forty-six studies with 13,624 older patients were included. Severe infection was seen in 51% (95% CI– 36-65%, I2–95%) patients while 22% (95% CI– 16-28%, I2–88%) were critically ill. Overall, 11% (95% CI– 5-21%, I2–98%) patients died. The common comorbidities were hypertension (48, 95% CI– 36-60% I2–92%), diabetes mellitus (22, 95% CI– 13-32%, I2–86%) and cardiovascular disease (19, 95% CI – 11-28%, I2–85%). Common symptoms were fever (83, 95% CI– 66-97%, I2–91%), cough (60, 95% CI– 50-70%, I2–71%) and dyspnoea (42, 95% CI– 19-67%, I2–94%). Overall, 84% (95% CI– 60-100%, I2–81%) required oxygen support and 21% (95% CI– 0-49%, I2–91%) required mechanical ventilation. Majority of studies had medium to high risk of bias and overall quality of evidence was low for all outcomes. Conclusion Approximately half of older patients with COVID-19 have severe infection, one in five are critically ill and one in ten die. More high-quality evidence is needed to study outcomes in this vulnerable patient population and factors affecting these outcomes.

Download Full-text

The Effects of Technological Interventions on Social Participation of Community-Dwelling Older Adults with and without Dementia: A Systematic Review

Journal of Clinical Medicine ◽

10.3390/jcm10112308 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2308

Author(s):

Pascale Heins ◽

Lizzy M. M. Boots ◽

Wei Qi Koh ◽

An Neven ◽

Frans R. J. Verhey ◽

...

Keyword(s):

Systematic Review ◽

Older Adults ◽

Social Isolation ◽

Social Participation ◽

Methodological Quality ◽

Well Being ◽

Community Dwelling ◽

Cochrane Library ◽

Technological Interventions ◽

Community Dwelling Older Adults

Social isolation in community-dwelling older adults with dementia is a growing health issue that can negatively affect health and well-being. To date, little attention has been paid to the role of technology in improving their social participation. This systematic review aims to provide a systematic overview of the effects of technological interventions that target social participation in community-dwelling older adults with and without dementia. The scientific databases Medline (PubMed), PsycINFO, CINAHL, Web of Science, and the Cochrane Library were systematically searched and independently screened by two reviewers. Results were synthesized narratively. The methodological quality of included studies was independently assessed by two reviewers. In total, 36 studies of varying methodological quality were identified. Most studies evaluated social networking technology and ICT training programs. Three studies focused on people with dementia. Quantitative findings showed limited effects on loneliness, social isolation, and social support. Nevertheless, several benefits related to social participation were reported qualitatively. Social interaction, face-to-face contact, and intergenerational engagement were suggested to be successful elements of technological interventions in improving the social participation of community-dwelling older adults. Rigorous studies with larger sample sizes are highly needed to evaluate the long-term effects of technology on the multidimensional concept of social participation.

Download Full-text