Adverse drug reaction (ADR) occurrence and evaluation in elderly inpatients

Bowman, Lee; Carlstedt, Bruce C.; Hancock, Emily; Black, Curtis D.

doi:10.1002/(sici)1099-1557(199601)5:1<9::aid-pds192>3.0.co;2-2

Cited by 44 publications

(27 citation statements)

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“…In common with the Australian study of ADR-related hospitalizations [5], increasing age was a significant factor in re-admissions overall, and particularly in re-admissions due to ADRs. No differences were found in re-admission or ADR rates with gender, despite the findings of previous work in the study hospital [1,2] and in the ADR literature [14][15][16][17] which have suggested that ADR rates are higher in females. However, the totality of the evidence in the literature is not conclusive [18,19], and a large study of emergency medical re-admissions in a UK hospital has actually shown the opposite, in that the overall re-admission risk at 12 months was significantly higher in males [20].…”

Section: Number Of Reactions N = 91 (Number Of Patients)contrasting

confidence: 82%

Emergency re‐admissions to hospital due to adverse drug reactions within 1 year of the index admission

Davies

Green²,

Mottram

et al. 2010

Brit J Clinical Pharma

108

102

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WHAT IS ALREADY KNOWN ABOUT THIS SUBJECTADRs in hospital patients are a significant burden, though how often ADRs cause re-admission to hospital has not been well documented in the literature. WHAT THIS STUDY ADDS• One fifth of patients re-admitted to hospital within 1 year of discharge from their index admission were re-admitted due to an adverse drug reaction. • Admission to a medical ward, elderly age and prescription of anti-platelet agents or diuretics were identified as risk factors for re-admission due to ADRs.• Since up to 50% of these reactions were possibly avoidable, better methods of medication review in both hospital and primary care, in conjunction with a clinical review, are needed to enable improved prescribing practices that will be essential for improving the benefit-harm balance of medicines. AIMThe proportion of re-admissions to hospital caused by ADRs is poorly documented in the UK. The aim of this study was to evaluate the impact of ADRs on re-admission to hospital after a period as an inpatient. METHODSOne thousand patients consecutively admitted to 12 wards were included. All subsequent admissions for this cohort within 1 year of discharge from the index admission were retrospectively reviewed. RESULTSOf the 1000 patients included, 403 (40.3%, 95% CI 39.1, 45.4%) were re-admitted within 1 year. Complete data were available for 290 (70.2%) re-admitted patients, with an ADR contributing to admission in 60 (20.8%, 95% CI 16.4, 25.6%) patients. Presence of an ADR in the index admission did not predict for an ADR-related re-admission (10.5% vs. 7.2%, P = 0.25), or re-admission overall (47.2% vs. 41.2%, P = 0.15). The implicated drug was commenced in the index admission in 33/148 (22.3%) instances, with 37/148 (25%) commenced elsewhere since the index admission. Increasing age and an index admission in a medical ward were associated with a higher incidence of re-admission ADR. The most frequent causative drugs were anti-platelets and loop diuretics, with bleeding and renal impairment the most frequent ADRs. Over half (52/91, 57.1%) of the ADRs were judged to be definitely or possibly avoidable. CONCLUSIONSOne fifth of patients re-admitted to hospital within 1 year of discharge from their index admission are re-admitted due to an ADR. Our data highlight drug and patient groups where interventions are needed to reduce the incidence of ADRs leading to re-admission.

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Section: Number Of Reactions N = 91 (Number Of Patients)contrasting

confidence: 82%

Emergency re‐admissions to hospital due to adverse drug reactions within 1 year of the index admission

Davies

Green²,

Mottram

et al. 2010

Brit J Clinical Pharma

108

102

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“…More than 75% of ADRs leading to hospitalization are related to known pharmacological properties (type A), which are dose‐related, thus these are usually predictable and potentially avoidable [2]. Type A ADRs are more common in the elderly [26]. Therefore, the risk of side‐effects must be balanced against the benefits to older patients of the increased use of powerful pharmaceutical agents in treating diseases.…”

Section: Discussionmentioning

confidence: 99%

Repeat adverse drug reactions causing hospitalization in older Australians: a population‐based longitudinal study 1980–2003

Zhang

Holman

Preen

et al. 2006

Brit J Clinical Pharma

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What is already known about this subject • Adverse drug reactions (ADRs) are a major cause of morbidity in older patients and represent a major burden on healthcare. • The rate of ADR‐related hospital stays in older people in Western Australia (WA) increased fivefold from 1981 to 2002. • Little information is available regarding repeated ADRs in the elderly and the drugs most responsible. What this study adds • Repeat ADR‐related hospitalizations have consistently increased faster than first‐time ADRs in the elderly in WA from 1980 and had reached 30.3% of all ADRs by 2003. • The mean time interval declined with each successive repeat ADR and the most common repeat ADRs were nausea and vomiting, haemorrhage due to anticoagulants, drug‐induce osteoporosis and poisoning by cardiovascular agents. • Strategies to ensure the safer use cardiovascular agents, corticoids, nonsteroidal anti‐inflammatory drugs, opioids and, in particular, anticoagulants, in this population are warranted. Aim To examine trends in the rate of repeat adverse drug reactions (ADRs) causing hospitalization in older Australians and to identify the most common ADRs and drugs most often implicated in repeat and first‐time ADRs. Methods Analysis of routinely collected hospital record administrative data, with International Classification of Diseases external cause codes for ADRs extracted from the Western Australia (WA) Hospital Morbidity Data System and WA Death Register, for people aged ≥60 years in 1980–2003. Results A total of 37 296 people aged ≥60 years with an ADR‐related hospitalization were identified. Among them, 6853 (18.4%) patients had 10 212 repeat ADRs. Repeat ADRs consistently increased from 1980 and reached 30.3% of all ADRs by 2003. The mean time interval declined with each successive repeat ADR (810, 606 and 299 days for the first, second and higher ranked repeat episodes, respectively). The most common repeat ADRs were nausea/vomiting (8.0%), haemorrhage due to anticoagulants (5.5%), drug‐induced osteoporosis (4.8%) and poisoning by cardiovascular agents (3.9%). The drugs most often involved in repeat ADRs were cardiovascular agents (15.6%), antineoplastic drugs (11.0%), corticoids (10.1%), anticoagulants (8.6%), antirheumatics/nonsteroidal anti‐inflammatory drugs (5.1%) and opioids (4.9%). The trends of anticoagulants and antineoplastic drugs implicated in repeat ADRs were still rising at the end of the study. The specific drug classes involved in repeat ADRs differed in relative importance from first‐time ADRs. Conclusions Repeat ADR‐related hospitalizations have consistently increased in elderly Australians from 1980 to 2003. Strategies to ensure the safer use of medicines, in particular anticoagulants, in this population are warranted.

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“…Identified risk factors for adverse drug events include polypharmacy, age ≥65 years, female gender, drugs with anarrow therapeutic index and impaired renal and/or hepatic function (Carbonin et al. 1991, Bowman et al. 1996, Van den Bemt et al.…”

Section: Introductionmentioning

confidence: 99%

“…Adverse drug reactions (ADRs) are a leading cause of morbidity and mortality in the health care process (Einarson 1993, Classen et al 1997, Muehlberger et al 1997, Lazarou et al 1998, Moore et al 1998, Pirmohamed et al 2004, Kongkaew et al 2008, the majority being preventable (Brennan et al 1991, Classen et al 1997, Dormann et al 2000, Vincent et al 2001, Winterstein et al 2002, Ferner & Aronson 2010. Identified risk factors for adverse drug events include polypharmacy, age ‡65 years, female gender, drugs with anarrow therapeutic index and impaired renal and/or hepatic function (Carbonin et al 1991, Bowman et al 1996, Van den Bemt et al 2000, Hanlon et al 2003, Routledge et al 2003, Nguyen et al 2006, Hajjar et al 2007, Zopf et al 2008a,b, Helldén et al 2009) . These are also important determinants of an increased severity of symptoms, excess length of hospital stay, extra costs and increased attributable mortality (Classen et al 1997, Pardo et al 2009.…”

Section: Introductionmentioning

confidence: 99%

Multiple drug exposure as a risk factor for the seriousness of adverse drug reactions

Macedo

Alves

Craveiro

et al. 2011

Journal of Nursing Management

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Adverse drug reaction (ADR) occurrence and evaluation in elderly inpatients

Cited by 44 publications

References 0 publications

Emergency re‐admissions to hospital due to adverse drug reactions within 1 year of the index admission

Emergency re‐admissions to hospital due to adverse drug reactions within 1 year of the index admission

Repeat adverse drug reactions causing hospitalization in older Australians: a population‐based longitudinal study 1980–2003

Multiple drug exposure as a risk factor for the seriousness of adverse drug reactions

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