Recognition of adverse drug events in older hospitalized medical patients

Abstract

ObjectiveTo assess medical teams’ ability to recognize adverse drug events (ADEs) in older inpatients.MethodsThe study cohort comprised 250 patients aged 65 years or older consecutively admitted to Internal Medicine wards of three hospitals in the Netherlands between April and November 2007. An independent expert team identified ADEs present upon admission or occurring during hospitalization by a structured retrospective patient chart review. For all ADEs identified, the expert team assessed causality, severity, preventability, and recognition by medical teams.ResultsThe medical teams did not recognize 19.9 % of all ADEs present upon admission {60.4 ADEs [95 % confidence interval (CI) 51.5–70.8] per 100 hospitalizations} and 20.3 % of all ADEs occurring during the hospital stay [47.2 ADEs (95 % CI 39.4–56.5) per 100 hospitalizations]. Unrecognized ADEs were significantly more often ADEs with possible causality (p=0.014, df=1), ADEs caused by medication errors (p<0.001, df=1), and ADEs not manifesting as new symptoms (p<0.001, df=1). The medical teams did not recognize 23.2 % of mild to moderately severe ADEs and 16.5 % of severe, life-threatening, or fatal ADEs. The recognition of ADEs varied with event type.ConclusionsThe recognition of ADEs by medical teams was substantial for those ADEs with evident causality and with clinically apparent and severe consequences. ADEs mimicking underlying pathologies with a lower severity went unrecognized much more often, as did those resulting only in abnormal laboratory values. Tools to improve the recognition of ADEs by medical teams should, therefore, focus on those ADEs that are more challenging to detect.

Drug-drug interactions and adverse drug reactions in polypharmacy among older adults: an integrative review

“…Of the 47 records resulting from the search strategies, 24 (51.1%) full-text articles were retrieved for review concerning ADR 11 - 18 , 20 , 24 - 25 , 28 - 29 , 34 - 36 , 38 - 40 , 46 , 51 - 52 , 54 , 56 ) , 14 (29.8%) DDI 21 - 23 , 27 , 30 - 33 , 41 , 43 - 45 , 49 , 53 and nine (19.1%) are related to both DDI and ADR 19 , 26 , 37 , 42 , 47 - 48 , 50 , 55 , 57 , according to Figures 2 and 3.…”

The type and incidence of adverse drug events in ageing medical inpatients and their effect on length of hospital stay

“…ADEs can occur in any patient; however, older people (generally defined as greater than 65 years) are more susceptible than younger adults . Their vulnerability can be attributed to a number of causes including an increased number of co‐morbidities, a decline in physiological function and a high medication burden . Approximately 88% of older Australians are taking more than one medication .…”

“…Approximately 88% of older Australians are taking more than one medication . Age‐related decline in physiological function affects the pharmacokinetics and pharmacodynamics of drugs and predisposes ageing patients to higher drug exposure and the potential for drug‐related harm …”

Physicians need to take the lead in deprescribing

“…Unfortunately, apart from the clear‐cut cases where a drug is directly implicated in causing toxicity, deprescribing is rarely done in hospital practice . Part of the problem is under‐recognition of drug‐related geriatric syndromes on the part of hospital physicians and pharmacists …”