Adverse drug reactions and cognitive function among hospitalized older adults

Onder, Graziano; Gambassi, Giovanni; Scales, Christian J; Cesari, Matteo; Vedova, Cecilia Della; Landi, Francesco; Bernabei, Roberto

doi:10.1007/s00228-002-0493-y

Cited by 55 publications

(40 citation statements)

References 35 publications

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“…In keeping with our findings, it has been suggested that patients with dementia tend to underreport common symptoms compared to nondemented subjects [43] and physicians underdiagnose ADEs in patients with cognitive impairment [15] . It has also been suggested that demented patients may be evaluated less carefully by physicians leading to an underestimation of ADEs in this population [44] and that neuropsychiatric ADEs associated with psychotropic medications can be underrecognized leading to increased psychotropic use [45] .…”

Section: Discussionsupporting

confidence: 77%

“…Cognitive function as a risk factor for ADEs has also been a subject of debate with both increased [37,41] and decreased risk [15] being described. In keeping with our findings, it has been suggested that patients with dementia tend to underreport common symptoms compared to nondemented subjects [43] and physicians underdiagnose ADEs in patients with cognitive impairment [15] .…”

Section: Discussionmentioning

confidence: 99%

“…Less common unpredictable idiosyncratic reactions are also more common in older patients [1] . In patients with impaired cognition, the risk of ADEs does not appear to be increased [15] , however, reduced adherence [16] and increased sensitivity to anticholinergics [17] have been demonstrated. Furthermore, these subjects have a unique drug use pattern compared to those with intact cognition [18,19] .…”

Section: Introductionmentioning

confidence: 99%

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Adverse Drug Events in Cognitively Impaired Elderly Patients

Ganjavi¹,

Herrmann²,

Rochon³

et al. 2007

Dement Geriatr Cogn Disord

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Background/Aims: Adverse drug events (ADEs) are a frequent problem encountered in the elderly. The aim of this study was to elucidate the factors that influence ADEs in an elderly population with cognitive impairment. Methods: 242 patients were recruited from dementia clinics and assessed after 6 months for ADEs. The use of natural health products (NHPs) was also documented. Results: Backward logistic regression found that higher age (OR = 1.06; 95% CI 1.01–1.12), and greater cognitive impairment (OR = 0.94; 95% CI 0.90–0.98) were associated with an increased risk of developing an ADE while the use of NHPs (OR = 0.32; 95% CI 0.13–0.79) was associated with a decreased risk (χ² = 27.6, p < 0.001). Conclusion: Risk of ADEs increased with greater age and cognitive impairment but decreased with the use of NHPs.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Adverse Drug Events in Cognitively Impaired Elderly Patients

Ganjavi¹,

Herrmann²,

Rochon³

et al. 2007

Dement Geriatr Cogn Disord

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“…26 Second, adverse drug effects (ADEs) are common in patients with dementia, 27–30 yet ADEs are difficult to detect by clinicians because these patients have difficulty expressing the symptoms they feel. 31,32 Third, this population has frequent clinical complications associated with a high risk of 6-month mortality, and the time to benefit from many medications exceeds this life expectancy.…”

Section: Discussionmentioning

confidence: 99%

Use of Medications of Questionable Benefit in Advanced Dementia

Tjia

Briesacher

Peterson³

et al. 2014

JAMA Intern Med

107

102

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“…Interestingly, a number of these risks were not found to be significant predictors of ADR in this current study. For example, well known factors such as age [23], previous history of ADR, gender [24], heart failure [8], prior bleeding on admission [25], renal impairment [26], the use of certain drug classes [27], and abnormalities in certain laboratory parameters [6] were not retained in our final model. The omission of these previously identified risk factors could possibly be explained by the inclusion criteria, which recruited a broader range of ages.…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of a Risk Model for Predicting Adverse Drug Reactions in Older People during Hospital Stay: Brighton Adverse Drug Reactions Risk (BADRI) Model

et al. 2014

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BackgroundOlder patients are at an increased risk of developing adverse drug reactions (ADR). Of particular concern are the oldest old, which constitute an increasingly growing population. Having a validated clinical tool to identify those older patients at risk of developing an ADR during hospital stay would enable healthcare staff to put measures in place to reduce the risk of such an event developing. The current study aimed to (1) develop and (2) validate an ADR risk prediction model.MethodsWe used a combination of univariate analysis and multivariate binary logistic regression to identify clinical risk factors for developing an ADR in a population of older people from a UK teaching hospital. The final ADR risk model was then validated in a European population (European dataset).ResultsSix-hundred-ninety patients (median age 85 years) were enrolled in the development stage of the study. Ninety-five reports of ADR were confirmed by independent review in these patients. Five clinical variables were identified through multivariate analysis and included in our final model; each variable was attributed a score of 1. Internal validation produced an AUROC of 0.74, a sensitivity of 80%, and specificity of 55%. During the external validation stage the AUROC was 0.73, with sensitivity and specificity values of 84% and 43% respectively.ConclusionsWe have developed and successfully validated a simple model to use ADR risk score in a population of patients with a median age of 85, i.e. the oldest old. The model is based on 5 clinical variables (≥8 drugs, hyperlipidaemia, raised white cell count, use of anti-diabetic agents, length of stay ≥12 days), some of which have not been previously reported.

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Adverse drug reactions and cognitive function among hospitalized older adults

Abstract: Cognitive impairment is associated with a lower detection rate of ADRs, and it represents a confounder of the association between age and ADRs.

Cited by 55 publications

References 35 publications

Adverse Drug Events in Cognitively Impaired Elderly Patients

Adverse Drug Events in Cognitively Impaired Elderly Patients

Use of Medications of Questionable Benefit in Advanced Dementia

Development and Validation of a Risk Model for Predicting Adverse Drug Reactions in Older People during Hospital Stay: Brighton Adverse Drug Reactions Risk (BADRI) Model

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