Comparing Characteristics of Adverse Drug Events Between Older and Younger Adults Presenting to a Taiwan Emergency Department

Abstract

To compare the proportion, seriousness, preventability of adverse drug events (ADEs) between the older adults (≥65 years old) and younger adults (<65 years old) presenting to the emergency department (ED), we conducted a prospective observational cohort study of patients 18 years and older presenting to the ED. For all ED visits between March 1, 2009, and Feb 28, 2010, investigators identified ADEs and assessed cases using the Naranjo adverse drug reaction probability scale. Outcomes (proportion, seriousness, and preventability of ADE, length of ED stay, and hospitalization) and associated variables were measured and compared between younger and older adults. The results showed that of 58, 569 ED visits, 295 older adults, and 157 younger adults were diagnosed as having an ADE and included in our analysis. The proportion of ADEs leading to ED visits in the older group, 14.3 per 1000 (295/20,628), was significantly higher than the younger group of 4.1 per 1000 (157/37,941).The older group with ADE had a longer ED stay (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.9–6.4 for stay ≥ 24 hours) and larger proportion of preventable ADEs (OR 2.2, 95% CI 1.4–3.6) than the younger group, but there was no significant difference in terms of serious ADEs (OR 0.6, 95% CI 0.3–1.3 for fatal and life threatening) and hospitalization (OR 1.5, 95% CI 0.9–2.6) between the 2 groups. In addition, patients in the older group were more likely to be male, to have symptoms of fatigue or altered mental status, to involve cardiovascular, renal, and respiratory systems, and to have higher Charlson comorbidity index scores, higher number of prescription medications, and higher proportion of unintentional overdose. In conclusion, the proportion of ADE-related ED visits in older adults was higher than younger adults, and many of these were preventable. The most common drug categories associated with preventable ADEs in the older adults were antithrombotic agents, antidiabetic agents, and cardiovascular agents.

To study the pattern of adverse drug reactions among patients hospitalized in the medical wards of a tertiary care hospital

“…20,22,23 Causality assessment concluded that most common were probable ADRs (61.2%) followed by possible (32.3%), unlikely (5.0%) and certain (1.5%) respectively. Which was similar to the study by Goyal et al and Palanisamy et al 13,15 Considering the severity of reaction 74.2% ADRs were observed moderate in nature, 13 11,14,15,20,25,26 In our study it was found that 42.9% ADRs remitted by dechallenging the suspected drugs. Similar study by Rao et al suggested that the suspected drug was withdrawn for management of the ADRs in majority (56.6%) of the reports.…”

“…Similar results were reported by Goyal et al (59.3%), Chen et al (68.5%) and Palanisamy et al (59%) in male and (41%) were female whereas Lobo et al and Koh et al concluded in their studies that gender was not a risk factor to develop ADRs. [13][14][15][16][17] In our study age group 41-60 years showed high incidence of ADRs (38.4%) in both the genders. Similar findings were shown by Palanisamy et al who observed the same age group (41-60 years) with 42.71% of ADRs.…”

Cross-sectional study of the association between functional status and acute kidney injury in geriatric patients

“…The overall mean Charlson comorbidity index was 7.7 ± 2.4. Past reports indicated that elderly Taiwanese patients admitted to an emergency department had a mean Charlson comorbidity index of 3.1 ± 2.1 [ 15 ]. A total of 59 patients (38.9 %) presented with AKI at admission.…”

Potentially high-risk medication categories and unplanned hospitalizations: a case–time–control study

“…This finding is in agreement with a prior study done by Chen et al . in which they report that medications requiring therapeutic drug monitoring, including anticonvulsants, are more likely to be associated with emergency visits in the elderly compared to the younger group29. The narrow therapeutic index of anticonvulsants as well as reduced drug clearance, polypharmacy and multimorbidity due to aging30 might all explain the higher hospitalization risk associated with anticonvulsant in the elderly.…”