Incident adverse drug reactions in geriatric inpatients: a multicentred observational study

Lavan, A; Eustace, Joseph A.; Dahly, Darren; Flanagan, Evelyn; Gallagher, Paul; Cullinan, Shane; Petrovic, Mirko; Perehudoff, Katrina; Gudmondsson, Adalsteinn; Samúelsson, Ólafur; Sverrisdóttir, Ástrós; Cherubin, Antonio; Dimitri, Frederica; Rimland, Joe; Cruz-Jentoft, Alfonso J.; Vélez-Díaz-Pallarés, Manuel; Lozano-Montoya, Isabel; Soiza, Roy L.; Subbarayan, Selvarani; O’Mahony, Denis

doi:10.1177/2042098617736191

Cited by 26 publications

(25 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Prior to finalizing the trial protocol we conducted a non-interventional feasibility study at the same sites that are participating in the trial [23]. The feasibility study highlighted several challenges that led us to modify our initial trial design and our approach to the assessment of ADRs in the current trial.…”

Section: Discussionmentioning

confidence: 99%

The effect of SENATOR (Software ENgine for the Assessment and optimisation of drug and non-drug Therapy in Older peRsons) on incident adverse drug reactions (ADRs) in an older hospital cohort – Trial Protocol

et al. 2019

Self Cite

View full text Add to dashboard Cite

Background: The aim of this trial is to evaluate the effect of SENATOR software on incident, adverse drug reactions (ADRs) in older, multimorbid, hospitalized patients. The SENATOR software produces a report designed to optimize older patients' current prescriptions by applying the published STOPP and START criteria, highlighting drug-drug and drug-disease interactions and providing non-pharmacological recommendations aimed at reducing the risk of incident delirium.

show abstract

Section: Discussionmentioning

confidence: 99%

The effect of SENATOR (Software ENgine for the Assessment and optimisation of drug and non-drug Therapy in Older peRsons) on incident adverse drug reactions (ADRs) in an older hospital cohort – Trial Protocol

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…This is in the range of previous studies describing the incidence of ADRs in geriatric patients admitted to hospital. 58–61 As reported by others, 62–65 electrolyte disorders and exsiccosis induced by diuretics, and falls associated with fall-risk-increasing drugs were the most common ADRs. A thorough medication review should result in a marked reduction of objectively measured and subjectively reported ADRs, as we prove in our intervention group.…”

Section: Discussionmentioning

confidence: 69%

Influence of pharmacist intervention on drug safety of geriatric inpatients: a prospective, controlled trial

Nachtigall¹,

Heppner²,

Thürmann

2019

Therapeutic Advances in Drug Safety

View full text Add to dashboard Cite

Background: Demographic shift leads to an increasing number of geriatric patients suffering from multimorbidity and resulting polypharmacy. Polypharmacy is shown to be associated with drug-related problems (DRPs) and increased morbidity. For Germany, a hospital-based intervention may be successful optimizing of polypharmacy. The aim of this study was to reduce DRPs in geriatric inpatients by a structured pharmacist’s intervention and to measure the acceptance rate of pharmaceutical recommendations. Methods: This study followed an open, prospective, quasi-randomized, controlled design and was conducted in a geriatric department in a teaching hospital in Germany. Patients of all sexes were included, with a minimum age of 70 years, a written informed consent and a regular intake of at least five drugs daily. Primary outcome was the percentage of patients having a DRP at admission and discharge. A DRP was defined as a prescription without indication or a relevant drug–drug interaction or prescription of a potentially inappropriate medication or presence of an adverse drug reaction. Recommendations were classified and discussed face to face. Statistical analyses were performed using a full-set analysis and a matched-pairs design. Results: Within 12 months, 411 patients were recruited with median age of 82 years (intervention: n = 209; control: n = 202). Median number of drugs at admission was 10 (range 5–24), at discharge 9 (range 3–21). In the intervention group, the percentage of patients with a DRP was reduced from 86.6% to 56.0%; in the control group, from 76.7% to 76.2% ( p value < 0.001). Medication appropriateness index score was reduced by 56% in the intervention group and by 0.2% in the control group ( p value < 0.001). Implementation rate of the pharmaceutical recommendation was 80%. Conclusion: This prospective controlled trial showed that a pharmacist’s intervention was successful in optimizing polypharmacy in geriatric inpatients.

show abstract

“…To limit potential bias from selective ADR reporting and to ensure ADRs were not missed, a “trigger list” comprising the 12 most common drug‐related adverse events (AEs) was used . This list was derived from previous studies within our research group and aims to standardize the identification and classification of ADRs .…”

Section: Methodsmentioning

confidence: 99%

Adverse Drug Reactions in an Oncological Population: Prevalence, Predictability, and Preventability

et al. 2019

Self Cite

View full text Add to dashboard Cite

Background Our goal was to determine (a) the prevalence of multimorbidity and polypharmacy in patients with cancer and (b) the prevalence, predictability, and preventability of adverse drug reactions (ADRs) causing/contributing to hospitalization. Materials and Methods We conducted a 12‐month prospective observational study of patients aged ≥16 years admitted to an oncology center. Older adults were aged ≥70 years. Results We enrolled 350 patients: 52.3% (n = 183) female, mean age 63.6 years (SD 12.1), 36.6% (n = 121) aged ≥70 years. Multimorbidity (≥2 conditions) was identified in 96.9%; 68% had ≥5 conditions. The median number of medications was 6 (interquartile range [IQR] 4–8); 47% were prescribed ≥6 medications and 11.4% ≥11 medications. Older adults had higher numbers of comorbid conditions (7 [IQR 5–10] vs. 5 [IQR 3–7]) and were prescribed more medications (median 7 [IQR 4–9] vs. 4 [IQR 2–7]). ADRs caused/contributed to hospitalization in 21.5% (n = 75): 35.8% (n = 72) of emergency admissions and 4.7% (n = 3) of elective admissions. The most common ADRs were neutropenia with infection (25.3%), dyspepsia/nausea/vomiting (20%), and constipation (20%). Causative medications included systemic anticancer therapies (SACTs; 53.3%), opioids (17.3%), corticosteroids (6.7%), and nonsteroidal anti‐inflammatory drugs (5.3%). ADR prevalence was similar in older and younger adults secondary to SACTs (8.3% vs. 13.1%), non‐cancer medications (10.7% vs. 8.3%), and both (0% vs. 1.3%). ADRs were predictable in 89.3% (n = 67), definitely avoidable in 29.3% (n = 22), and possibly avoidable in 33.3% (n = 25). No association was identified between ADRs and age, gender, daily medication number, length of stay, or death. No ADR predictor variables were identified by logistic regression. Conclusion More than 21% of admissions to an oncology service are ADR‐related. ADRs are caused by both SACTs and non‐cancer‐specific medications. The majority are predictable; ≥60% may be preventable. Patients with cancer have high levels of multimorbidity and polypharmacy, which require vigilance for related adverse outcomes. Implications for Practice A diagnosis of cancer often occurs in patients with multimorbidity and polypharmacy. Cancer can cause an altered physiological environment, placing patients at risk of drug‐drug interactions, drug‐disease interactions, and adverse drug reactions (ADRs). This study identified that ADRs caused or contributed to one in five hospital admissions of patients with cancer. ADRs were caused by systemic anticancer therapies (SACTs) in 53.3% of cases and non‐cancer medications in 45.4% of cases, and a combination of both in 1.3%. ADRs occurred in similar frequencies in older and younger patients secondary to SACTs (8.3% vs. 13.1%, p = .295), non‐SACTs (10.7% vs. 8.3%, p = .107), and a combination of both (0% vs. 1.3%, p = .240). The majority of ADRs were predictable (89.3%) and potentially preventable (62.6%). These findings support the need for increased awareness of medication‐related adversity in pa...

show abstract

Incident adverse drug reactions in geriatric inpatients: a multicentred observational study

Abstract: This feasibility study established the rates of incident ADRs across the six study sites. The ADR predictive power of ADRROP and GerontoNet ADR risk scales were limited in this population.

Cited by 26 publications

References 16 publications

The effect of SENATOR (Software ENgine for the Assessment and optimisation of drug and non-drug Therapy in Older peRsons) on incident adverse drug reactions (ADRs) in an older hospital cohort – Trial Protocol

The effect of SENATOR (Software ENgine for the Assessment and optimisation of drug and non-drug Therapy in Older peRsons) on incident adverse drug reactions (ADRs) in an older hospital cohort – Trial Protocol

Influence of pharmacist intervention on drug safety of geriatric inpatients: a prospective, controlled trial

Adverse Drug Reactions in an Oncological Population: Prevalence, Predictability, and Preventability

Contact Info

Product

Resources

About