Adverse drug reactions are an important cause of hospital admissions in older people. A fall before admission may indicate a severe adverse drug reaction.

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Adverse reactions to drugs in elderly patients are a major clinical problem.1 Patients' perceptions about the presence of drug reactions may contribute to their earlier detection, 2 but no studies have related patients' complaints about adverse reactions to the objective presence of reactions, and no study has been performed in elderly patients. Subjects, methods, and resultsAll admissions of patients aged 70 and over to our medical wards from 1 February to 1 May 1994 were analysed. We excluded patients transferred from other wards and those readmitted within a month. Patients gave their informed consent. Data were collected on drug treatment, and patients were asked whether they thought any of their medical problems were caused by their drugs. The presence and severity of an adverse reaction was assessed from the history, examination, and laboratory tests, using the methods of Kramer et al 3 A total of 128 patients were identified (24% of all admissions), but 22 were excluded because of transfer, readmission, refusal, or death. The 106 patients had a mean age of 78 (70-91); 60 were women. Of the total, 102 were receiving drug treatment (mean 5.9 drugs); 44 patients admitted (42%, 95% confidence interval 32% to 51%) had had one or more adverse reactions and 25 had had severe reactions (24%, 16% to 32%). None of the 15 deaths during the study were directly related to an adverse drug reaction.Comparison of patients with and without an adverse reaction causing admission was feasible in 12 patients with gastrointestinal bleeding or haematuria: 5 were taking an oral anticoagulant, which was used by only 9 of the 94 patients who were not admitted for bleeding (P = 0.009). In multivariate analysis a fall before admission (odds ratio 51.3 (3.2 to 834.3), P = 0.006), the presence of gastrointestinal bleeding or haematuria (19.8 (4.4 to 88.6), P < 0.001), and the use of three or more drugs (14.5 (1.2 to 175.3), P = 0.04) were significant factors in patients with severe adverse reactions (table). Severe reactions in 5 patients admitted after falling included orthostatic hypotension (2 patients were taking diuretics), drug intoxication (1 patient taking carbamazepine and 1, phenobarbitone), and anaemia caused by gastrointestinal bleeding (1 taking a non-steroidal anti-inflammatory drug).The 102 patients having drug treatment were asked whether they had complaints caused by their drugs. A correct opinion about the presence of adverse drug reactions was found in 73 of the 93 patients (79%, 70% to 87%) who could answer the question: 28 correctly recognised a reaction, while 45 who did not complain of an adverse reaction correctly affirmed its absence-a sensitivity of 0.70 and a specificity of 0.85. The negative predictive value of the question was 0.79 and the positive predictive value 0.78. Eighteen of the 25 patients with a severe reaction could not, however, implicate the drug in their current illness; these severe reactions were unrecognised by 14 of the 57 patients who did not complain of adverse reactions (24.6%) and i...

Antipsychotic use may be associated with reporting of hyponatraemia. Moreover, the concomitant use of medication associated with hyponatraemia potentially leads to under-reporting of antipsychotic-associated hyponatraemia. We advise testing patients whose psychiatric and/or physical condition deteriorates while on antipsychotics for hyponatraemia.

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