The phenotype of adverse drug effects: Do emergency visits due to adverse drug reactions look different in older people? Results from the ADRED study

Abstract

Older patients in particular suffer from adverse drug reactions (ADR) when presenting in the emergency department. We aimed to characterise the phenotype of those ADRs, to be able to recognise an ADR in older patients. Methods: Cases of ADRs in emergency departments collected within the multicentre prospective observational study (ADRED) were analysed (n = 2215). We analysed ADR-associated diagnoses, symptoms and their risk profiles. We present frequencies and odds ratios (OR) with 95% confidence intervals for adults (18-64 years) compared to older adults (≥65 years; young-old 65-79, old-old ≥80 years) and regression coefficients (B) for each year of age. Results: Most prominent differences were seen for drug-associated confusion, dehydration, and bradycardia (OR 6.70 [1.59-28.27], B .054; OR 6.02 [2.41-15.03], B .081, and 4.82 [2.21-10.54], B .040), more likely seen in older adults. Bleedings were reported in all age groups, but gastrointestinal bleedings occurred with more than doubled chance in older adults (OR 2.46 [1.77-3.41], B .030), likewise did other bleedings such as haemorrhage from respiratory passages (OR 2.89 [1.37-6.11], B.036). Falls were more likely in older adults (OR 2.84 [1.77-4.53], B .030), while dizziness was frequent in both age groups. Conclusion: Our data point to differences in symptoms of ADRs between adults and older individuals, with dangerous drug-associated phenomena in the older adult such as bleedings or falls. Physicians should consider drug-associated origins of symptoms in older adults with an increased risk for serious health problems.

Adverse Drug Reactions in the Emergency Department: Is There a Role for Pharmacogenomic Profiles at Risk?—Results from the ADRED Study

“…Adverse drug reactions (ADRs) are common phenomena that impact our health system. Around 6.5% of all consultations in the hospital emergency department (ED) are caused by serious ADRs [1][2][3] that mainly affect older, multi-medicated patients [4]. The majority of ADRs is expected to be dose-related, thereby underlining the importance of choosing the right dose for a patient [5].…”

CYP2D6 in the Brain: Potential Impact on Adverse Drug Reactions in the Central Nervous System—Results From the ADRED Study

“…Analyses on the second and third most frequent CNS symptoms syncope and headache were included as a control testing for nonvigilancerelated CNS ADR symptoms. As patients presented in median with two symptoms (Just et al, 2020c), we conducted sensitivity analyses with ADR symptoms frequently associated with dizziness.…”

“…Around 6.5% of all unplanned emergency department (ED) admissions are likely to be caused by ADRs (Lazarou et al, 1998;Pirmohamed et al, 2004;Schurig et al, 2018), often affecting older and multi-medicated adults (Hanlon et al, 1997;Just et al, 2020a). These patients seem to be especially vulnerable to drug-related symptoms of the CNS (Just et al, 2020c), and drugs acting within the CNS often get suspected for causing an ADR (Just et al, 2020a). Frequent symptoms related to CNS drugs in older patients include syncope and falls, most likely due to their sedative properties (Stingl et al, 2020).…”

Präoperative Medikation: aktuelle Herausforderungen in der Pharmakotherapie

“…Etwa 6,5 % aller Konsultationen der Notaufnahme lassen sich auf UAW zurückführen [3,4]. Betroffen sind in erster Linie ältere, multimorbide und multimedizierte Patienten mit einer medianen Arzneimitteleinnahme von 7 unterschiedlichen Wirkstoffen in der Dauertherapie [5]. Hier kann die Arzneimitteltherapie schnell unübersichtlich werden.…”