Interventions to Reduce Adverse Drug Event-Related Outcomes in Older Adults: A Systematic Review and Meta-analysis

Tecklenborg, Sarah; Byrne, Catherine J.; Cahir, Caitriona; Brown, Lamorna; Bennett, Kathleen

doi:10.1007/s40266-019-00738-w

Cited by 31 publications

(38 citation statements)

References 30 publications

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“…ADEs are an important cause of morbidity and emergency department (ED) visits and hospitalisations among the elderly (Budnitz et al, 2011). Although some studies have reported that the incidence of ADEs may be as high as 25% (Tecklenborg et al, 2020), a rate that is fourfold higher than in young adults (aged 18-64 years), the evidence that age is the sole predisposing factor for ADEs in the elderly is still debated (Davies and O'Mahony, 2015).…”

Section: Introductionmentioning

confidence: 99%

Risk of Hospitalization Associated with Cardiovascular Medications in the Elderly Italian Population: A Nationwide Multicenter Study in Emergency Departments

et al. 2021

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Background: There is a significant gap in knowledge addressing cardiovascular (CV) medications safety in elderly. In this context, our purposes were to define clinical and pharmacological characteristics of outpatients’ adverse drug events (ADEs) related to CV medications leading to emergency department (ED) visits in the elderly Italian patients according to different age groups, and to evaluate the risk of hospitalization associated to ADEs in this population.Methods: A multicentre, retrospective study was performed on reports of suspected ADEs collected between 2007–2018 in 94 EDs involved in the MEREAFaPS Study. Elderly patients who experienced one or more CV medications-related ADEs leading to ED visit were selected. Patients’ characteristics, suspected (ATC classes B and C) and concomitant drugs, and ADE description were collected. Elderly patients were stratified into three age groups (65–74, 75–84, and ≥85 years) and compared to adults (18–64 years). Logistic regression analyses were used to estimate the reporting odds ratios (RORs) with 95% confidence intervals (CIs) of ADE-related hospitalization adjusting for sex, presence of two or more suspected drugs, concomitant drugs, and one or more comorbidities.Results: Among elderly, 16,926 reports of suspected ADE related to CV medications were collected, and 6,694 (39.5%) resulted in hospitalization. Patients were mostly female, Caucasians, and middle-old (75–84). 78.9% of patients were treated with only one suspected drug, and 71.9% and 47.1% reported concomitant medications and comorbidities, respectively. Compared to adults, risk of hospitalization was significantly higher for middle-old and oldest-old patients exposed to vitamin K antagonists (1.29 [1.09–1.52] and 1.56 [1.30–187]), direct thrombin inhibitors (3.41 [1.44–8.08] and 4.12 [1.67–10.17]), antiplatelets (1.51 [1.26–1.81] and 2.09 [1.71–2.57]), and beta-blockers (1.89 [1.38–2.59 and 2.31 [1.60–3.35]). Overall, a higher risk of hospitalization was observed for renin-angiotensin system inhibitors (1.32 [1.04–1.68], 1.65 [1.32–2.06], and 2.20 [1.70–2.85]), presence of two or more concomitant drugs, and concomitant conditions.Conclusion: Our real-world findings underline relevant safety aspects of CV medications in the elderly Italian population. ED clinicians must always consider the higher risk of hospitalization related to the use of CV drugs in elderly, particularly in oldest-old ones, for antiarrhythmics, beta-blocking agents, renin-angiotensin system inhibitors, antiplatelets, and anticoagulants.

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Section: Introductionmentioning

confidence: 99%

Risk of Hospitalization Associated with Cardiovascular Medications in the Elderly Italian Population: A Nationwide Multicenter Study in Emergency Departments

et al. 2021

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“…Nevertheless, the recent meta-analysis found no statistically significant benefit on hospitalization from any intervention designed to reduce MRH [14]. Compliance with specific criteria does not always protect against MRH, especially in comorbid and older adults suffering from frailty or cognitive disability [15].…”

Section: Introductionmentioning

confidence: 99%

Prevalent medication-related harm identified in patients admitted to geriatric ward: cross-sectional and survival-based contributors

Bień¹

2020

Polish Archives of Internal Medicine

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“…Community pharmacists are well positioned to prevent, detect, discuss and solve DRPs because of their accessibility for all patients, their overview of prescribed and over-the-counter medications and because they are experts in medication use. Consequently, primary care interventions in older patients, such as pharmacist-led medication reviews performed with tools to detect DRPs or inappropriate medication use [12][13][14], have become a key strategy to prevent and to reduce these harms [5,12]. Pazan et al recently (2019) identified 76 tools to optimise medication in older people [15], with the Ghent Older People's Prescriptions community Pharmacy Screening (GheOP 3 S)-tool as an example of a screening tool to detect DRPs or PIP with high clinical relevance for older patients…”

Section: Introductionmentioning

confidence: 99%

Ghent Older People’s Prescriptions Community Pharmacy Screening (GheOP3S)-Tool Version 2: Update of a Tool to Detect Drug-Related Problems in Older People in Primary Care

et al. 2021

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Background The Ghent Older People’s Prescriptions community Pharmacy Screening (GheOP 3 S)-tool was developed in 2016 as a screening tool to detect drug-related problems (DRPs) and to help in performing medication reviews in older people (≥ 65 years). Objective This study aimed to revise and update the GheOP 3 S-tool. Methods Users’ comments were collected to improve the usability and appropriateness of the original GheOP 3 S-tool, followed by a two-round modified Delphi process according to the RAND/UCLA appropriateness method. This included a literature review, a round zero meeting, a first written round (with 15 international and multidisciplinary experts) and a second face-to-face round (with 11 experts) to change, delete or add GheOP 3 S-criteria. An additional third round with 14 community pharmacists was organised to preserve criteria applicable in the current community pharmacy practice. Results The updated GheOP 3 S-tool consists of five lists of DRPs and a new addendum containing medications that should be avoided or used with caution in older people with reduced renal function. During the first two rounds, related criteria were grouped, 14 criteria were added and 17 criteria were deleted from the original tool. All criteria were deemed applicable in round 3. This led to a final tool (version 2) with 64 GheOP 3 S-criteria. Conclusion GheOP 3 S-criteria were revised and updated according to experts’ agreement on their clinical relevance and recent scientific evidence. Future studies should investigate the impact of pharmacist-led medication reviews with GheOP 3 S-tool version 2 on clinical, humanistic and economic outcomes in primary care. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-021-00862-6.

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Interventions to Reduce Adverse Drug Event-Related Outcomes in Older Adults: A Systematic Review and Meta-analysis

Cited by 31 publications

References 30 publications

Risk of Hospitalization Associated with Cardiovascular Medications in the Elderly Italian Population: A Nationwide Multicenter Study in Emergency Departments

Risk of Hospitalization Associated with Cardiovascular Medications in the Elderly Italian Population: A Nationwide Multicenter Study in Emergency Departments

Prevalent medication-related harm identified in patients admitted to geriatric ward: cross-sectional and survival-based contributors

Ghent Older People’s Prescriptions Community Pharmacy Screening (GheOP3S)-Tool Version 2: Update of a Tool to Detect Drug-Related Problems in Older People in Primary Care

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