Adverse drug reactions in elderly patients

Abstract

Many studies from around the world show a correlation between increasing age and adverse drug reaction (ADR) rate, at least for some medical conditions. More than 80% of ADRs causing admission or occurring in hospital are type A (dose-related) in nature, and thus predictable from the known pharmacolog y of the drug and therefore potentially avoidable. Frail elderly patients appear to be particularly at risk of ADRs and this group is also likely to be receiving several medicines. The toxicity of some drug combinations may sometimes be synergistic and be greater than the sum of the risks of toxicity of either agent used alone. In order to recognize and to prevent ADRs (including drug interactions), good communication is crucial, and prescribers should develop an effective therapeutic par tnership with the patient and with fellow health professionals. Undergraduate and postgraduate education in evidence-based therapeutics is also vitally important. The use of computer-based decision support systems (CDSS) and electronic prescribing should be encouraged, and when problems do occur, health professionals need to be aware of their professional responsibility to report suspected adverse drug events (ADEs) and ADRs. 'Rational' or 'obligatory' polypharmacy is becoming a legitimate practice as increasing numbers of individuals live longer and the range of available therapeutic options for many medical conditions increases. The clear risk of ADRs in this situation should be considered in the context that dose-related failure of existing therapy to manage the condition adequately may be one of the most important reasons for admission of the elderly to hospital. Thus, age itself should not be used as a reason for withholding adequate doses of effective therapies.

Patterns, Predictors and Outcomes of Polypharmacy among Elderly Perioperative Patients in the General Surgical Department of a Tertiary Care Teaching Hospital

“…ADRs due to drug-drug interactions are a common cause of admission to the hospital and are an important cause of mortality and morbidity. Studies done after 1985 have shown that the ADR rate in European and American geriatric settings are greater by at least 20% when compared to the general medicine setting [17] . Another 4-y prospective study done among geriatric residents of nursing homes from USA has reported that the mean number of drugs per patient in the ADR group was 7.8 while the mean number of drugs in the remaining geriatric population was a mere 3.3 [18] .…”

Medication management among home-dwelling older patients with chronic diseases: Possible roles for community pharmacists

“…However, older adults are at higher risk of adverse drug reactions (ADR) due to age-related pharmacokinetic and pharmacodynamic changes and polypharmacy (1). They are also more susceptible to non-adherence and to practical difficulties with medication taking such as cognitive impairment and various functional problems (2).…”

Combined intervention programme reduces inappropriate prescribing in elderly patients exposed to polypharmacy in primary care

“…The increased number of medications used by a patient correlates with poorer compliance, increased risk of drug-drug interactions and adverse drug reactions (ADRs) and increased economic burden [4][5][6][7][8][9].…”