Potentially inappropriate prescribing and the risk of adverse drug reactions in critically ill older adults

IntroductionMultimorbidity is a major challenge for current healthcare systems and professionals. From the different approaches that have been proposed to analyse this issue, the hypothesis of the existence of association patterns of different chronic conditions is gaining visibility. In addition, multimorbidity can be associated to polypharmacy, which can lead to a higher risk of potentially inappropriate prescribing (PIP) and consequently to adverse drug reactions (ADRs). The general objective of this novel study is to identify the association between PIP, multimorbidity patterns, polypharmacy and the presence of ADRs in older patients admitted for exacerbation of chronic diseases.Methods and analysisThe MoPIM (morbidity, potentially inappropriate medication) study is a multicentre prospective cohort study of an estimated sample of 800 older (≥65 years) patients admitted to five general hospitals in Spain due to an exacerbation of a chronic disease. Patients referred to home hospitalisation, admitted due to an acute process or with a fatal outcome expected at the time of admission are excluded. Sociodemographic data, chronic morbidities and geriatric syndromes, number of chronic prescribed medications, PIP at admission to hospital and on discharge, according to the newest screening tool of older screening tool of older person's potentially inappropriate prescriptions/screening tool to alert doctors to right treatment criteria, and ADRs during hospitalisation are being collected. Multimorbidity patterns will be identified using cluster analyses techniques, and the frequency of polypharmacy, PIP and ADRs will be calculated. Finally, the possible relationship between those indicators will be identified through bivariate and multivariate analyses.Ethics and disseminationThe project has been approved by the clinical research ethics committees of each centre: Comité Ético de investigación Clínica del Parc Taulí, Comitè Ètic d'Investigació Clínica Osona per a la Recerca i Educació Sanitàries (FORES), Comité de Ètica de la Investigación con Medicamentos (CEIm)-Parc de Salut MAR, Comité Ético de Investigación Clínica de Euskadi, Comité de Ética de Investigación del Hospital Universitario de Canarias. The results will be actively and mainly disseminated through publication in peer-reviewed journals and communications in scientific conferences.Trial registration numberNCT02830425.

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What Types of Inappropriate Prescribing Predict Adverse Drug Reactions in Older Adults?

Annals of Pharmacotherapy ◽

10.1345/aph.1p182 ◽

2010 ◽

Vol 44 (6) ◽

pp. 1110-1111 ◽

Cited By ~ 10

Author(s):

Joseph T Hanlon ◽

Kenneth E Schmader

Keyword(s):

Older Adults ◽

Adverse Drug Reactions ◽

Inappropriate Prescribing ◽

Drug Reactions

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A retrospective evaluation of the association between potentially inappropriate prescribing and adverse drug reactions among hospitalized elderly Nigerians

10.21203/rs.2.15400/v1 ◽

2019 ◽

Author(s):

Ajibola Sule Saka ◽

Frasia Oosthuizen ◽

Manimbulu Nlooto

Keyword(s):

Logistic Regression ◽

Musculoskeletal Disorders ◽

Adverse Drug Reactions ◽

Inappropriate Prescribing ◽

The Elderly ◽

Beers Criteria ◽

Potentially Inappropriate Prescribing ◽

Drug Reactions ◽

Anticholinergic Medications ◽

Elderly Inpatients

Abstract Background Potentially inappropriate prescribing is associated with adverse clinical outcomes in the elderly. The Beers Criteria were developed to improve the quality of medication prescribing and safety to the elderly. However, the nexus between the Criteria’s potentially inappropriate medicines (PIMs) and adverse drug reactions (ADRs) remains controversial in clinical practice. This study aimed to evaluate the association between the 2015 American Geriatrics Society-Beers’ (AGS-Beers) PIMs and ADRs among elderly inpatients. Methods A cross-sectional retrospective study was carried out among elderly patients aged ≥ 60 years that were hospitalized between 1st January and 31st December 2016 at the internal medicine wards of a Nigerian University teaching hospital. Eligible elders that were hospitalized or died within 24 hours were excluded from the study. The medical records of eligible participants were randomly selected and information including patients’ socio-demographics, medication and medical histories, and medicines utilization during hospitalization were extracted from the records. Two clinical pharmacists evaluated the medical charts for PIMs using the 2015 AGS-Beers Criteria and ADRs using the Naranjo algorithm. Bivariate analyses and subsequently, a binary logistic regression, were carried out to determine the association between independent variables and ADRs with P<0.05 being considered significant. Results A total of 268 participants mean age, 70.53 (8.22) years were evaluated. According to the AGS-Beers Criteria, 32.1% (86/268) received at least one PIM, 13.8% (37/268) experienced 43 ADRs during hospitalization of which diclofenac was the most implicated medication for it (8/43, 18.6%). The AGS-Beers’ PIMs were not associated with ADRs in the bivariate analysis (p=0.24). The diagnoses of musculoskeletal disorders (OR=7.38, 95%CI=2.68-20.34, p<0.001) and the use of anticholinergic medications (OR=4.02,95%CI=1.04-15.58, p=0.04) were significantly associated with ADRs in the logistic regression. Conclusion The elderly inpatients experienced ADRs which were associated with diagnoses of musculoskeletal disorders and anticholinergic medications but not the 2015 AGS-Beers’ PIM in the Nigerian teaching hospital. Keywords: adverse drug reaction, Beers criteria, elderly inpatient, potential inappropriate prescribing Running title: Potential inappropriate prescribing and adverse drug reactions in elderly

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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.

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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

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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

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Common Causes and Characteristics of Adverse Drug Reactions in Older Adults: A Retrospective Study

10.21203/rs.3.rs-58795/v3 ◽

2020 ◽

Author(s):

Seong-Dae Woo ◽

Jiwon Yoon ◽

Go-Eun Doo ◽

Youjin Park ◽

Youngsoo Lee ◽

...

Keyword(s):

Older Adults ◽

Adverse Drug Reactions ◽

Drug Reactions ◽

Younger Patients ◽

Iodinated Contrast ◽

Common Causes ◽

Aging Populations ◽

Pharmacovigilance Center ◽

Inflammatory Drugs ◽

Rate Ratios

Abstract Background: Aging populations are often accompanied by comorbidity and polypharmacy, leading to increases in adverse drug reactions (ADRs). We sought to evaluate the causes and characteristics of ADRs in older Korean adults (≥65 years) in comparison to younger individuals (<65 years). Methods: Of 37,523 cases reported at a Korean pharmacovigilance center from 2011 to 2018, we reviewed 18,842 ADRs of certain or probable causality on the basis of WHO-UMC criteria. We estimated the number of ADRs per 1,000 patients exposed to the major culprit drugs, and incidence rate ratios were obtained to assess high- and low-risk medications in older adults. Results: In total, 4,152 (22.0%) ADRs were reported for 3,437 older adults (mean age, 74.6 years and 57.3% female). Tramadol (rate ratio, 1.32; 95% confidence interval [CI], 1.21-1.44; P <0.001) and fentanyl (1.49, 1.16-1.92, P =0.002) posed higher risks of ADRs in the older adults, whereas nonsteroidal anti-inflammatory drugs (NSAIDs) (0.35, 0.30-0.40, P <0.001) and iodinated contrast media (ICM) (0.82, 0.76-0.89, P <0.001) posed lower risks. Ratios of serious ADRs to NSAIDs (odds ratio, 2.16; 95% CI, 1.48-3.15; P <0.001) and ICM (2.09, 1.36-3.21, P= 0.001) were higher in the older adults than in the younger patients. Analgesics primarily elicited cutaneous ADRs in the younger patients and gastrointestinal reactions in the older adults. ICM more commonly led to anaphylaxis in the older adults than the younger patients (3.0% vs. 1.6%, P =0.019). Conclusion: For early detection of ADRs in older adults, better understanding of differences in the causes and characteristics thereof in comparison to the general population is needed.

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Older Adults' Response to Analgesic Adverse Drug Reactions: A Pilot Study

Pain Management Nursing ◽

10.1016/j.pmn.2018.01.008 ◽

2018 ◽

Vol 19 (4) ◽

pp. 333-339 ◽

Cited By ~ 2

Author(s):

Deborah Dillon McDonald ◽

Sarah Coughlin ◽

Candy Jin

Keyword(s):

Older Adults ◽

Pilot Study ◽

Adverse Drug Reactions ◽

Drug Reactions

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Study of adverse drug reactions and clinical profile of elderly in relation to polypharmacy

Asian Journal of Medical Sciences ◽

10.3126/ajms.v10i6.22757 ◽

2019 ◽

Vol 10 (6) ◽

pp. 80-84

Author(s):

Nagaraja BS ◽

Keerthana Sharma

Keyword(s):

Older Adults ◽

Adverse Drug Reactions ◽

The Elderly ◽

Control Group ◽

Case Group ◽

Drug Reactions ◽

Age Related ◽

Improve Compliance ◽

Clinical Conditions

Background: Polypharmacy is a becoming more prevalent in older adults and adverse risk increases with age-related change. Adverse drug reactions (ADRs) are common in older adults and worrisome aspect of treatment in elderly. Aims and Objective: The study aimed to identify the common clinical conditions leading to polypharmacy and to compare the adverse drug profiles of the 2 groups. Materials and Methods: This case-control study was conducted in Hospitals attached to BMCRI, where 200 patients aged 65 or more were interviewed. 100 elderly patients using 5 or more drugs were identified as cases and assessed against a control group of 100 patients. Results: Our study found that ADRs were found to be three times higher in individuals on polypharmacy compared to the control group (OR 3.4675 95% CI 1.6241 to 7.4035). The most commonly occurring ADRs were dyspepsia (OR 1.9259), drowsiness (OR 3.5926) and fatigue (OR 1.5319) with increased incidence in the case group. The most common conditions associated with polypharmacy were found to be hypertension (53%), diabetes mellitus(46%), COPD(14%) and IHD(14%). 66% of the study group had two or more of the above diseases, whereas in the control group only 32% had multiple illnesses. The most commonly prescribed medications were antihypertensives (61%), hypolipidemics (44%), antiplatelets (41%) and antibiotics(40%). Conclusion: Polypharmacy in the elderly comes with a significant increase in adverse effects. The reduced pill burden will not only decrease ADRs and improve compliance, but will also result in greater patient satisfaction and mental health, thereby improving the quality of geriatric care.

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