Adverse drug reactions in older patients: an Italian observational prospective hospital study

Conforti, Anita; Costantini, Davide; Zanetti, F.; Moretti, Ugo; Grezzana, Matteo; Leone, Roberto

doi:10.2147/dhps.s29287

Cited by 68 publications

(71 citation statements)

References 27 publications

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“…ADRs are also one of the main reasons for hospitalization in older patients living in the community [4]. The proportion of all hospital admissions due to ADRs has ranged from 6–12% among older patients [1, 4–7]. While individual risk factors for ADRs have been identified [6, 8], health professionals are not able to easily identify elderly community-dwelling outpatients who are at high risk of being hospitalized due to an ADR.…”

Section: Introductionmentioning

confidence: 99%

Prediction of Hospitalization due to Adverse Drug Reactions in Elderly Community-Dwelling Patients (The PADR-EC Score)

et al. 2016

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BackgroundAdverse drug reactions (ADRs) are the major cause of medication-related hospital admissions in older patients living in the community. This study aimed to develop and validate a score to predict ADR-related hospitalization in people aged ≥65 years.MethodsADR-related hospitalization and its risk factors were determined using a prospective, cross-sectional study in patients aged ≥65 years admitted to two hospitals. A predictive model was developed in the derivation cohort (n = 768) and the model was applied in the validation cohort (n = 240). ADR-related hospital admission was determined through expert consensus from comprehensive reviews of medical records and patient interviews. The causality and preventability of the ADR were assessed based on the Naranjo algorithm and modified Schumock and Thornton criteria, respectively.ResultsIn the derivation sample (mean [±SD] age, 80.1±7.7 years), 115 (15%) patients were admitted due to a definite or probable ADR; 92.2% of these admissions were deemed preventable. The number of antihypertensives was the strongest predictor of an ADR followed by presence of dementia, renal failure, drug changes in the preceding 3 months and use of anticholinergic medications; these variables were used to derive the ADR prediction score. The predictive ability of the score, assessed from calculation of the area under the receiver operator characteristic (ROC) curve, was 0.70 (95% confidence interval (CI) 0.65–0.75). In the validation sample (mean [±SD] age, 79.6±7.6 years), 30 (12.5%) patients’ admissions were related to definite or probable ADRs; 80% of these admissions were deemed preventable. The area under the ROC curve in this sample was 0.67 (95% CI 0.56–0.78).ConclusionsThis study proposes a practical and simple tool to identify elderly patients who are at an increased risk of preventable ADR-related hospital admission. Further refinement and testing of this tool is necessary to implement the score in clinical practice.

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Section: Introductionmentioning

confidence: 99%

Prediction of Hospitalization due to Adverse Drug Reactions in Elderly Community-Dwelling Patients (The PADR-EC Score)

et al. 2016

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“…In our study found that antihypertensives, antidiabetics, antimicrobials, H 2 receptor antagonists, Analgesics and some antifungals require dose modifications. Anita Conforti et al; kirsch-Volk et al; also observed similar results in drug dose modification 21,22 . In this baseline study, 6 subjects were contraindicated to drugs.…”

Section: Discussionmentioning

confidence: 61%

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2015

IJPSR

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Objective:The objectives are to assess the drug dose administration and reduce the dose toxicity in geriatric patients. Method: A Prospective interventional study has been carried out on drug dose administration in geriatric patients with respect to creatinine clearance rate at a tertiary care hospital for about 6 months. A total number of 204(47 baseline+157study) geriatric patients are included who has attended the general medicine ward. Results: In our study, we observed that Creatinine clearance was decreased as age increases. In study population 60-65yrs (48.6ml/min) was more, in 80-85yrs (29.2ml/min) was less and also similar in baseline study. So we can understand that geriatrics has a moderate renal failure. In a baseline among 47 subjects, 53% require dose modifications. In baseline 11 (44%) subjects experienced adverse drug reactions. Mostly Augmented types of adverse effects were observed. Among 157 study population, 28% were undergone dose modification by the suggestion of a pharmacist. It was observed that in 31 (70.4%) dose of the drug was reduced, in 6(13.6%) dose interval was increased, in 7(16%) both dose and dose interval was changed. Among the study population, 8(18%) were experienced adverse drug reactions. As compared to baseline, in study population the adverse drug reactions and dose burden on the renal system is reduced. Conclusion: The geriatric patient's creatinine clearance was decreased with respect to the age. It was observed that dose modifications were needed based on Creatinine clearance in geriatrics. The clinical outcome of the patient was improved, and adverse effects were reduced after dose modification. Pharmacist intervention plays a pivot role in avoiding drug-related problems and improves the quality of life.

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“…7 27 28 If we focus on the safety profile of anticoagulant drugs, we find that the potential sex differences in the onset of adverse reactions have also been analysed in several meta-analyses, with varying results 29–31. However, in our study, sex as a risk factor behaved differently.…”

Section: Discussionmentioning

confidence: 66%

Adverse drug reactions to anticoagulants in Spain: analysis of the Spanish National Hospital Discharge Data (2010–2013)

et al. 2017

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ObjectiveTo describe and analyse hospitalisations for adverse drug reactions (ADRs) involving anticoagulants. We also analysed the progress of the reactions over time, the factors related with ADRs.DesignA retrospective, descriptive, epidemiological study.SettingThis study used the Spanish National Hospital Discharge Database (Conjunto Mínimo Básico de Datos, CMBD), over a 4-year period.ParticipantsWe selected CMBD data corresponding to hospital discharges with a diagnosis of ADRs to anticoagulants (International Classification of Diseases-Ninth Revision, Clinical Modification (ICD-9-CM) code E934.2) in any diagnostic field during the study period.Main outcome measuresWe calculated the annual incidence of ADRs to anticoagulants according to sex and age groups. The median lengths of hospital stay and in-hospital mortality (IHM) were also estimated for each year studied. Bivariate analyses of the changes in variables according to year were based on Poisson regression. IHM was analysed using logistic regression models. The estimates were expressed as ORs and their 95% CI.ResultsDuring the study period, 50 042 patients were hospitalised because of ADRs to anticoagulants (6.38% of all ADR-related admissions). The number of cases increased from 10 415 in 2010 to 13 891 in 2013. Cumulative incidence of ADRs to anticoagulants was significantly higher for men than women and in all age groups. An adjusted multivariate analysis revealed that IHM did not change significantly over time. We observed a statistically significant association between IHM and age, with the highest risk for the ≥85 age group (OR 2.67; 95% CI 2.44 to 2.93).ConclusionsThe incidence of ADRs to anticoagulants in Spain increased from 2010 to 2013, and was significantly higher for men than women and in all age groups. Older patients were particularly susceptible to being hospitalised with an adverse reaction to an anticoagulant.

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Adverse drug reactions in older patients: an Italian observational prospective hospital study

Cited by 68 publications

References 27 publications

Prediction of Hospitalization due to Adverse Drug Reactions in Elderly Community-Dwelling Patients (The PADR-EC Score)

Prediction of Hospitalization due to Adverse Drug Reactions in Elderly Community-Dwelling Patients (The PADR-EC Score)

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Adverse drug reactions to anticoagulants in Spain: analysis of the Spanish National Hospital Discharge Data (2010–2013)

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