Adverse drug reactions in patients with gastroenterological diseases: does age increase the risk?

Abstract

Background: It has been claimed that the risk of adverse drug reactions increases with age. However, only limited data exist for disease‐group specific risks and none for patients with liver and gastrointestinal diseases. Aims: To determine the incidence and characteristics of adverse drug reactions and the physicians’ awareness of adverse drug reactions. Methods: During a 7‐month period, a prospective survey of 532 male patients (158 aged 65 years or older; 30%) was conducted on a hepatogastroenterological ward of a tertiary‐care university hospital, using intensive bedside and computer‐assisted drug surveillance methods. Results: No difference was found in the overall rate of adverse drug reactions between older and younger patients (25.9% vs. 24.2%) during 6213 treatment days. However, a significantly higher risk for developing adverse drug reactions could be shown for the elderly with biliary tract diseases (P < 0.01). Independently of age, patients suffering from gastric ulcers, acute episodes of pancreatitis, cholangitis or inflammatory bowel diseases were at high risk of adverse drug reactions. Adverse drug reaction‐associated mortality was encountered in four elderly and none of the younger patients. Secondary pharmacological effects and drug toxicity were the main types of adverse drug reactions for both age groups. Although 75.3% of the adverse drug reactions were predictable, only 37.5% of all adverse drug reactions were recognized by the staff physicians. Conclusion: In hepatogastroenterological patients, advancing age was not associated with an overall increased risk of adverse drug reactions except for patients with biliary tract diseases. In the elderly, adverse drug reactions were more severe and carried higher mortality. Guidelines and educational programs should be developed to increase the awareness of adverse drug reactions and their prevention, especially in high risk patients and, thus, to improve patient outcomes.

Factors Associated with Serious Adverse Reactions to Cholinesterase Inhibitors

“…[31] In the same way, age is usually considered as an independent risk factor for ADRs or for their serious nature, though this has been disputed. [12,13,31,32] In the current study, there is a clear and significant risk gradient in point estimates (from 1 for those below 75 years of age to 1.9 in those 85 years of age and above), although the risk did not appear significantly increased for patients aged 75-79 years or those aged 80-84 years compared with patients aged below 75 years. The association of the use of analgesic drugs with a significantly lower risk of reporting serious (rather than non-serious) ADRs has no clear pharmacological explanation.…”

“…These characteristics have been shown to constitute individual risk factors for adverse events and for serious adverse events with drugs in general. [12,13] According to a previous study, more than 50% of subjects aged 65 years or over use cardiovascular system drugs, including agents prescribed for arrhythmias and drugs that can induce arrhythmias. [14] The prevalence of respiratory comorbidities is not that high but many drugs used by the elderly can affect respiratory function; an example is benzodiazepines, which are consumed by many elderly subjects.…”

Medical negligence in drug associated deaths

“…Based on a study on the incidence of lethal adverse drug reactions in hospitalised patients in the United States 106.000 lethal ADR per year are expected [27]. Data on the incidence of ADR are mainly available for hospitalised patients [1][2][3][4][5][6][8][9][10][11][12][15][16][17][18][19][23][24][25][26][27][28]33,36,37,38,39]. Due to the study design and the evaluation of the outcome of the incidence varies considerably between different studies.…”

Predictive factors for effectiveness and safety of enoxaparin for total knee arthroplasty in aged Japanese patients: a retrospective review

“…In addition, enoxaparin has been associated with severe adverse drug events (ADE), such as bleeding, skin reaction, liver failure, and anemia [6–8]. ncreasing age is a common risk factor for ADE with many types of medication [9–11], and enoxaparin is no exception. Macie et al suggested that increasing age was a risk factor for bleeding during treatment with enoxaparin [12].…”