Adverse drug events occur in 15 percent or more of older patients presenting to offices, hospitals, and extended care facilities. These events are potentially preventable up to 50 percent of the time. Common serious manifestations include falls, orthostatic hypotension, heart failure, and delirium.
How common are adverse drug events in older adults?
Adverse drug events occur in 15 percent or more of older patients presenting to offices, hospitals, and extended care facilities. These events are potentially preventable up to 50 percent of the time.
How many adverse drug events are caused by patient errors?
Patient related errors can contribute to adverse drug events. In a study of 30 000 Medicare enrolees aged over 65 years followed for a 12 month period, 99 adverse drugs events (23.5% of all adverse drug events) and 30 potential adverse drug events (13.6% of potential adverse drug events) were attributed to patient error 84.
Are older adults becoming more sensitive to drugs?
Yet another example of the marked increase in the sensitivity of older adults to drugs has to do with stimulant drugs that are in the same family as amphetamines, or “speed.” Despite the dangers of these drugs for anyone, especially older adults, they are widely promoted and prescribed, including Ornade, TavistD, Entex LA and Actifed.
What is the prevalence of adverse drug events from antibiotics?
About four in five (82 percent) emergency department visits for ADEs from antibiotics alone are due to allergic reactions. Antibiotics are one of the most prescribed medication classes in the United States, which contributes to the high number of emergency department visits for adverse drug events from these medications.
How to reduce the risk of harm from adverse drug events in adults?
How many emergency department visits are there for adverse drug events?
How many people died from opioid overdoses in 2015?
How to prevent adverse drug events?
What is an ADE?
What to do if you are prescribed antibiotics?
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What percentage of geriatric hospitalizations are drug induced?
Hospitalizations — Adverse drug reactions (ADRs) are responsible for between 3 to 10 percent of all hospitalizations among older patients [82-85].
Why are adverse drug reactions common in elderly?
[13] Therefore, ADRs in elderly are largely contributed by prescribing error e.g., large doses of drugs without taking into account, the effect of age and frailty on drug disposition, especially renal and hepatic clearance.
What percentage of adverse drug reactions are reported?
Only 1% of Serious Adverse Drug Events Reported To FDA: Report.
What is the most common adverse drug reaction in the elderly?
Adverse drug reactions (ADRs) are common in older adults, with falls, orthostatic hypotension, delirium, renal failure, gastrointestinal and intracranial bleeding being amongst the most common clinical manifestations.
What is the most common adverse drug event?
An allergic reaction is the most common type of antibiotic-associated adverse drug event, so minimizing unnecessary antibiotic use is the best way to reduce the risk of adverse drug events from antibiotics.
Why are older people more sensitive to medications?
As we age, physiological changes can affect the way our body metabolises drugs, causing adverse reactions. Older people are more likely to be taking multiple medications ('polypharmacy'), which increases the risk of medications being implicated in hospital admissions.
How common are adverse events?
Adverse events (AE) frequently occur in any medical system, and at least one in ten patients are affected.
How common are adverse reactions?
Common side effects include upset stomach, dry mouth, and drowsiness. A side effect is considered serious if the result is: death; life-threatening; hospitalization; disability or permanent damage; or exposure prior to conception or during pregnancy caused birth defect.
How often do adverse drug reactions occur?
The incidence of severe or fatal adverse drug reactions is very low (typically < 1 in 1000) and may not be apparent during clinical trials, which are typically not powered to detect low-incidence ADRs.
Which combination places older adults at a higher risk for adverse drug events?
The combination of age-related changes and CKD places older patients at increased risk of drug accumulation and higher potential for adverse drug effects.
Are some people more prone to medication side effects?
A large range of drugs are susceptible to variations in metabolism that may make people prone to side effects. They include antidepressants, blood thinners, antibiotics and many more. For many drugs, a therapeutic trial starting with a low dose can help to determine whether you are extra sensitive to its effects.
What are high risk medications for the elderly?
- Phenobarbital (Luminal) - Mephobarbital (Mebaral) - Secobarbital (Seconal) - Butabarbital (Butisol) - Pentobarbital (Nembutal) - Butalbital and Butalbital combinations (Fioricet/Codeine) These medications are highly addictive and cause more adverse effects than most other sedatives in the elderly, greatly increasing ...
Why are older clients at risk for drug toxicity?
Elderly people are at a greater risk for adverse drug reactions (ADRs) because of the metabolic changes and reduced drug clearance associated with ageing; this risk is furthermore exacerbated by increasing the number of drugs used. Potential of drug-drug interactions is further increased by use of multiple drugs.
How does aging affect the way your body reacts to medicines?
The aging process can affect how the medication is absorbed, used in the body, and exits the body. Changes that decrease your body's ability to break down or remove certain medications from your system may mean that medications can stay in your body longer.
Why are geriatrics at higher risk for medication related problems?
Geriatric patients are at high risk of Drug Related Problems (DRPs) due to multi- morbidity associated polypharmacy, age related physiologic changes, pharmacokinetic and pharmacodynamics alterations. These patients often excluded from premarketing trials that can further increase the occurrence of DRPs.
What is the drug class commonly associated with adverse drug events in elderly patients?
Epidemiological studies have found that the classes of drugs most commonly associated with adverse drug reactions in the elderly include diuretics, warfarin, non-steroidal anti-inflammatory drugs (NSAIDs), selective serotonin reuptake inhibitors, beta-blockers and angiotensin-converting enzyme (ACE)-inhibitors.
Adverse Drug Events Are A Large Public Health problem.
Adverse drug events cause approximately 1.3 million emergency department visits each year. About 350,000 patients each year need to be hospitalized...
Some Medicines Require Blood Testing and These Are More Likely to Cause Serious Adverse Events.
Getting a blood test is one way to make sure the dose of your medicine is just right for you. More than 40 percent of emergency visits that require...
Unintentional Overdoses of Pain Relievers Cause Many Deaths.
However, overdoses of opioid analgesics have contributed to a national epidemic. In 2015, more than 15,000 people died from overdoses involving pre...
Sometimes Medicines Will Not Help Improve Your Health Condition.
Although antibiotics are good drugs for certain types of infections, they are also one of the types of medicines that cause the most emergency visi...
ASHP Guidelines on Adverse Drug Reaction Monitoring and Reporting
Ashp RepoRt GUIDeLINes oN ADR MoNItoRING AND RepoRtING oviding an indirect measure of the3. Pr quality of drug therapy through iden-tification of potential ADRs and antici-patory surveillance for high-risk drugs
Adverse Drug Events, Adverse Drug Reactions - Veterans Affairs
Adverse Drug Events, Adverse Drug Reactions and Medication Errors Frequently Asked Questions VA Center for Medication Safety And VHA Pharmacy Benefits Management Strategic Healthcare Group and the Medical Advisory Panel
Adverse drug reactions | Pharmacology Education Project
This 22-page open-access article published by Zahra Pourpak et al. in the Journal Recent Patents on Inflammation & Allergy Drug Discovery, describes in detail the WHO definition of adverse drug reactions (ADRs), the common features, classification according to Rawlins and Thompson and beyond.The authors also provide a comprehensive description of predictable Type A, which is dose-related ...
Drug Adverse Event Overview - Food and Drug Administration
Quarterly. However, please be advised that the data in this API may lag by 3 months or more at any given time, depending on when the quarterly FAERS data is released.
What are the most common causes of adverse drug events?
Among older adults, oral anticoagulants are the most common causes of adverse drug events (ADEs) leading to emergency room visits and emergent hospitalizations. Oral anticoagulants include warfarin and the direct-acting oral anticoagulants (DOACs) such as apixaban, dabigatran, edoxaban, and rivaroxaban.
What is an adverse drug event?
An adverse drug event is when someone is harmed by a medicine. Certain types of adverse drug events are more common for specific medication classes, such as low blood sugar (hypoglycemia) related to insulin use.
How did opioids contribute to the opioid epidemic?
In the United States, the use of opioid (narcotic) analgesics (pain-relievers) as part of pain management regimens has contributed to a poisoning epidemic. The increase in drug poisoning coincides with an increase in the prescription of major types of opioid analgesics, as physicians were encouraged to prescribe stronger analgesics (i.e., opioids) for pain management. When sales of opioid analgesics increased, the occurrences of opioid analgesics on death certificates increased at a similar rate. In 2013, the rate of drug poisoning deaths involving opioid analgesics remained higher than the rate for deaths involving heroin, but the rate of deaths involving heroin had almost tripled from 2010. The overall goal should be to identify ways to reduce deaths from opioid analgesics without reducing the quality of care for patients who legitimately need pain management. The CDC Guideline for Prescribing Opioids for Chronic Pain provides recommendations for safer prescribing of opioids among adults in primary care settings.
What are the most common causes of ADEs?
Warfarin, rivaroxaban, and dabigatran were among the top 10 most common causes of ADEs resulting in emergency department visits among older adults [1].
Why are anticoagulants important?
Anticoagulants (blood thinners) are important for preventing and treating blood clots, but are associated with an increased risk for bleeding. Using anticoagulants safely requires a careful balance between risks and benefits.
How many emergency department visits are caused by antibiotics?
In children 5 or younger, antibiotics cause more than half (56%) of estimated emergency department visits for ADEs. About four in five (82 percent) emergency department visits for ADEs from antibiotics alone are due to allergic reactions. Antibiotics are one of the most prescribed medication classes in the United States, ...
How to reduce the risk of anticoagulant bleeding?
Tip: To reduce the risk of anticoagulant-related bleeding, carefully follow your doctor’s advice about medication dosing, blood test monitoring, and diet, and do not discontinue your medication without first talking to your doctor.
How common are adverse drug reactions in elderly?
Adverse drug reactions (ADRs) are common in elderly people in community, residential care and hospital settings. In an Irish retrospective cohort study of 931 community dwelling people over 70 years (mean age 78 years, range 70–98 years), 674 (78%) people were established by self report and clinician review as having experienced at least one adverse drug event during the 6 month study period (95% CI 0.78, 0.98 ) 28. A prospective cohort study of long term care residents of nursing care facilities in Massachusetts found 410 adverse drug events in 2916 study participants (14.06%) over a 12 month period 29.
How does age affect medicine?
Ageing is associated with physiological changes that affect how medicines are handled, including alterations in volumes of drug distribution, metabolism and clearance which can prolong half-life, increase potential for drug toxicity and the likelihood of adverse drug reactions 20. In addition, elderly patients may have altered drug responsiveness, due to reduced homeostatic reserve in different organ systems e.g. the risk of orthostatic hypotension is greater in older people prescribed vasodilators, because of attenuated baroreceptor responses.
What is the term for the co-occurrence of two or more medical conditions that may or may not directly interact with each?
Multimorbidity refers to the co-occurrence of two or more medical or psychiatric conditions, which may or may not directly interact with each other within the same individual 5.
How many ADRs are avoidable?
In a prospective Italian study of 1756 consecutively admitted patients aged over 65 years, 45.1% of ADRs were classified as definitely avoidable and 31.4% as potentially avoidable 31.
What is a geriatric syndrome?
The term ‘geriatric syndrome’ is used to capture those clinical conditions in older persons which are by their nature non-specific and do not fit into a single deficit diagnosis. Geriatric syndromes presenting acutely in older people (delirium, falls, dizziness, urinary incontinence) have been identified as particular targets for medication rationalization. In a North American study of 1247 long-term care residents, the most common manifestations of an adverse drug event were delirium, oversedation and falls 43.
What are the most common adverse drug events in Irish communities?
In a study of Irish Community dwelling older people, the most common adverse drug events were bleeding or bruising associated with warfarin and aspirin, dyspepsia related to NSAID use and dizziness or unsteadiness with psychotropic drugs 28.
What are the main contributors to altered pharmacokinetics?
The main contributors to altered pharmacokinetics are age related changes in organ mass and blood circulation along with changes in body composition. A reduction in liver size of 25–35% 21and a decrease in hepatic blood flow of more than 40% are seen in healthy ageing 22,23, resulting in reduced drug clearance. Reduced hepatic size and blood flow also contribute to reduced first pass metabolism, which is relevant when considering the potential for increased bioavailability and adverse drug events for drugs with high hepatic extraction that undergo significant first pass metabolism e.g. propranolol.
What medications are inappropriate for older adults?
Included in this group are long-acting benzodiazepines, certain NSAIDs, digoxin, and pherosulphate. In addition, routine use of tricyclic antidepressants, ...
Why is it important to help older patients understand their medications?
Equally as important, providers need to help older patients understand the medications they are taking and the potential for negative drug interactions. When patients are aware of how their medications work, they may be less likely themselves to become the source of errors that lead to dangerous adverse drug events.
What changes are associated with aging?
Changes associated with aging, including loss of physiologic reserve, decline in hepatic and renal blood flow, and related metabolism, may render this population more vulnerable to adverse drug events.
What is medication error?
By contrast, a medication error is defined as an error in medication use, which is usually the result of inappropriate prescribing and/or dispensing or an error in interpretation of other information related to use of the drug. .
What is an adverse drug event?
Adverse drug events are described as any injury resulting from the medical use of a drug. This may be the result of intrinsic properties of the drug, of drug interactions when one mediation is combined with others, or of inappropriate dosage. These situations tend to occur more commonly in older patients. By contrast, a medication error is defined ...
What age group is the fastest growing?
There is a dramatic increase in the number of persons over the age of 65 and in particular, those 85 and older, who represent the fastest-growing segment of the US population. As adults age, they are more likely to use increasing numbers of both prescription and nonprescription medications, increasing the risk of drug interactions. ...
Can older adults take cognitive medications?
Sometimes older adults who are already being treated for cognitive deficits may not take those medications as prescribed. The result may be a perceived lack of efficacy and the clinician’s response may be to increase dosage, thereby increasing the risk for an adverse event. 4.
Why are older adults more prone to adverse events?
Older adults are more prone to adverse events due to the clinical complexity of their care rather than age-based discrimination.31A study of older adult outpatients who took five or more medications found that 35 percent experienced adverse drug events.32In addition, individuals with complex regimens had difficulty naming and explaining the purposes of medications and appeared to be at high risk for nonadherence.33The greater the medication complexity, the less likely the older adult is to adhere to the medication regimen.34The larger the number of medications, the more likely the older adult will be nonadherent.3, 9, 13, 19, 28, 35–46It is not only the number of medications but also the number of doses per day and actions related to taking medications that contribute to complexity of a medication regimen.34In a study of medication compliance, the compliance rate was 87 percent for daily dosing, 81 percent for twice a day, 77 percent for three times a day, and 39 percent for four times a day.47In addition, a change in prescribed drug regimen has been found to be a predictor of medication nonadherence in older adults.9Finally, the number of prescribing providers adds to the complexity of managing one’s medications, and persons with more than one prescribing provider were found to be prone to medication errors.16, 19
How much do older adults know about medications?
Studies of older adults’ knowledge of medications have found more than 50 percent knew the names and purpose of their medications; however, less than 25 percent knew the consequences of drug omission or toxic side effects.9, 16, 54, 102For example, one study of elderly patients with congestive heart failure found that 30 days after a new medication was prescribed, only 64 percent of the patients could identify when they were supposed to take their medicine.103Also, older adults were found to have insufficient knowledge of inhaler technique and understanding how medications can improve their asthma.104Noncompliant patients on anticoagulant therapy were more likely to report they did not know why their medication was prescribed.105In a study of OTC medication use, few older adults knew precautions related to the OTC drugs they were taking.61One study of older adult medication knowledge found that older adults understood prescribed medications better than OTC drugs, especially nutritional supplements.106
Why are older adults in nursing homes?
For many older adults, the ability to remain independent in one’s home depends on the ability to manage a complicated medication regimen. Nonadherence to medication regimens is a major cause of nursing home placement of frail older adults.1In the United States, an estimated 3 million older adults are admitted to nursing homes due to drug-related problems at an estimated annual cost of more than $14 billion.2Older adults are the largest users of prescription medication, yet with advancing age they are more vulnerable to adverse reactions to the medications they are taking. Approximately 30 percent of hospital admissions of older adults are drug related, with more than 11 percent attributed to medication nonadherence and 10–17 percent related to adverse drug reactions (ADRs).3–5Older adults discharged from the hospital on more than five drugs are more likely to visit the emergency department (ED) and be rehospitalized during the first 6 months after discharge.6Nursing interventions that assist older adults in managing their medications can help prevent unnecessary, costly nursing home admissions, hospitalizations, and ED visits, as well as improve their quality of life.
How to increase medication compliance?
Compliance aids such as pill box organizers have been found to increase medication adherence.16,78Medication schedules and calendars are helpful, especially in combination with education and use of a pill box.38,40,78,120,150,167,168In addition, electronic monitoring that provides feedback to the user increases adherence.141,169–171Older patients using a voice-reminder-message medication dispenser were significantly more compliant than those using a pill box or self-administering medications.172,173Patients using topical pilocarpine were significantly more compliant using an electronic medication alarm device.174Programs that use daily telephone reminder calls also have demonstrated increased medication compliance.155,175Several studies have demonstrated that dose simplification from two times a day to one time a day produces higher compliance and improved patient outcomes.122,176–182
Why do older people skip their medication?
A major reason that older adults skip doses or stop taking their medications is related to medication side effects. 9,11,16,26,38,46,89,91,93,110,125,159,161,162,191,195–198In a comparison of compliant and noncompliant patients in fluvastatin treatment, the noncompliant patients were more likely to experience side effects of the medication.199Six months after discharge for acute coronary syndrome, 8 percent of those taking aspirin,12 percent of those taking beta-blockers, 20 percent of those taking ACE inhibitors, and 13 percent of those taking statins had discontinued taking their medications.200
How to help older adults remember to take their medications?
There are a number of interventions to assist older adults with remembering to take their medications. One simple method is the use of memory cues that prompt patients to take their medications.148Development of memory cues must be tailored to the patient’s lifestyle.90,164Placing medication in a special place and use of a daily event such as meal time improve medication adherence.91,106,165,166A study that examined the most common ways older adults remembered to take their medications found the following methods to be beneficial: (1) placing containers in a particular location, (2) taking medications in association with meals/bedtime, (3) using a timed pill box, (4) reminders from another person, and (5) using written directions or a check-off list.159
Why do older people delay filling prescriptions?
If the cost of medication is viewed as high, older adults are more likely to not adhere to their medication regimen and be hospital ized.3, 11, 56Lack of funds, especially at the end of the month, is one reason older adults delay filling prescriptions.93In addition, chronically ill older adults are more likely to experience financial burdens associated with covering out-of-pocket costs for their prescription medications, cut back on medications due to cost, and use less medicines monthly.89, 93–98A study of use of medications after an increase in the copayment found a reduction in use of up to 45 percent in nonsteroidal anti-inflammatory drugs and 23 percent in antidiabetic drugs.99
Background
Prescribing of potentially inappropriate medications (PIMs) in adults who are ≥65 years old have been associated with adverse drug events (ADEs).
Method
All ADEs reported to the U.S. Food and Drug Administration Adverse Event Reporting System between 1 January 2004 and 31 December 2017 were reviewed. Data were collected for any ADEs associated with PIMs in adults with ages ≥65 years per the Beers Criteria, including demographics, ADE severity, and ADE date.
Results
The number of reported ADEs increased steadily over the 13-year period. Of the total 68 762 ADEs reported, 80.4% were serious ADEs and more women experienced ADEs (52.0%) than men (46.4%). Age group between 65–74 had a higher number of ADE reports than other groups. Of the 55 302 serious ADEs, 2723 were deaths.
Conclusion
ADEs from PIMs occurred frequently among older adults and steadily increased over 13 years. Anticoagulants had the highest proportion of the reported ADEs and most of the ADEs were of serious outcomes including death, disabilities, and hospitalisations. The ADEs potentially incur substantial healthcare costs for this population.
Why are older people more vulnerable to drug effects?
Decreased Blood-Pressure Maintaining Ability: Because older adults are less able to compensate for some of the effects of drugs, there is yet another reason why they are more vulnerable to adverse effects of drugs and more sensitive to the intended effects.
Why do drugs accumulate in older people?
Increased Sensitivity to Many Drugs: The problems of decreased body size, altered body composition (more fat, less water), and decreased liver and kidney function cause many drugs to accumulate in older people’s bodies at dangerously higher levels and for longer times than in younger people. These age-related problems are further worsened by ...
How much does the ability of the kidneys to clear drugs out of the body decrease?
By age 65, the filtering ability of the kidneys has already decreased by 30 percent.
What drugs cause blood pressure to drop?
Other categories of drugs that cause an exaggerated blood pressure drop include sleeping pills, tranquilizers, antidepressants, antipsychotic drugs, antihistamines, drugs for heart pain (angina) and antiarrhythmics.
What age do you have to be to get drugs out of your system?
In connection with the idea that drug-induced disease begins to get more common before age 60, it is interesting to note that in a number of studies comparing the way “older” people clear drugs out of the body with the way younger people do, the definition of older is above 50, and younger is below 50. 1.
Why do drugs stay in the body longer?
In addition, drugs that concentrate in fat tissue may stay in the body longer because there is more fat for them to accumulate in.
Why is the liver less able to process drugs?
Decreased Ability of the Liver to Process Drugs: Because the liver does not work as well in older adults, they are less able than younger people to process certain drugs so that they can be excreted from the body.
How to reduce the risk of harm from adverse drug events in adults?
To reduce the risk of harm from adverse drug events in adults: Keep a list of your medicines. Follow directions. Ask questions. Keep up with any blood testing recommended by your doctor. Take all medicines only as directed.
How many emergency department visits are there for adverse drug events?
Adverse drug events cause approximately 1.3 million emergency department visits each year. About 350,000 patients each year need to be hospitalized for further treatment after emergency visits for adverse drug events. People typically take more medicines as they age, and the risk of adverse events may increase as more people take more medicines.
How many people died from opioid overdoses in 2015?
However, overdoses of opioid analgesics have contributed to a national epidemic. In 2015, more than 15,000 people died from overdoses involving prescription opioids. Tip: Take pain relievers only as directed.
How to prevent adverse drug events?
To reduce the risk of harm from adverse drug events in adults: 1 Keep a list of your medicines 2 Follow directions 3 Ask questions 4 Keep up with any blood testing recommended by your doctor 5 Take all medicines only as directed
What is an ADE?
An adverse drug event (ADE) is when someone is harmed by a medicine. Older adults (65 years or older) visit emergency departments almost 450,000 times each year, more than twice as often as younger persons. Older adults are nearly seven times more likely than younger persons to be hospitalized after an emergency visit, ...
What to do if you are prescribed antibiotics?
If you are prescribed an antibiotic, make sure to take all the medicine as prescribed, even if you feel better. Do not save antibiotics for later. Learn more about adverse drug events from specific medicines, including antibiotics, blood thinners, and insulin. Top of Page. Top of Page.