Detection tools for prediction and identification of adverse drug reactions in older patients: a systematic review and meta-analysis

Abstract

Tools to accurately predict and detect adverse drug reactions (ADR) in elderly patients have not been developed. We aimed to identify and evaluate reports on tools that predict and detect ADR in elderly patients (≥ 60 years). In this review, we followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Databases were searched until January 2022 using key terms “elderly,” “adverse drug reaction,” and “detection instruments.” Eighteen studies met the inclusion criteria, and they examined assorted interventions: STOPP/START version 1/2 (n = 10), Beers Criteria 2012 or 2015 (n = 4), Systematic Tool to Reduce Inappropriate Prescribing (STRIP) (n = 2), Tool to Reduce Inappropriate Medications (TRIM) (n = 1), Medication Risk Score (MERIS) (n = 1), Computerized alert systems (n = 1), and Norwegian General Practice-Nursing Home criteria (n = 1). The interventions affected the number of potential prescription omissions (OR, 0.50 [0.37–0.69]; p < 0.0001; four studies). No apparent reduction in the number of drug interactions within 2 months (OR, 0.84 [0.70–1.02]; p = 0.08; two studies) and mortality (OR, 0.92 [0.76–1.12]; p = 0.41; three studies) was observed. In conclusion, there is no definitive and validated assessment tool for detecting and predicting ADR in elderly patients. Thus, more research on refining existing tools or developing new ones is warranted.

Prevalence of Potentially Inappropriate Prescriptions According to the New STOPP/START Criteria in Nursing Homes: A Systematic Review

“…To our knowledge, no systematic review of NH residents using the second version of the STOPP/START criteria has been published. Systematic reviews using the latest STOPP/START criteria have been focus on other populations such as older adults living in the community, older lung cancer patients, older adults undergoing surgery or hospitalized older adults [13,[36][37][38][39][40][41][42][43]. Existing studies using STOPP/START vs2 are scarce and heterogeneous, making it necessary to compile all the information published to date to summarize and centralize the main results of the use of these new criteria in this specific population.…”

Potentially Inappropriate Prescribing and Potential Prescribing Omissions and Their Association with Adverse Drug Reaction-Related Hospital Admissions

“…There are indications that using PIP and PPO criteria as a screening tool may result in lower prevalence of ADRs, although, to date, findings are not statistically significant [41]. Further research is ongoing using longitudinal cohort studies.…”

“…In total, 309 (39%; 95% CI [35][36][37][38][39][40][41][42] ADAPT patients had at least one PIP from Beers Table S2 (medications that are potentially inappropriate in most older adults), with the most frequent criteria being the use of zolpidem (N = 62 (8%); 95% CI 6-10). There were 198 (25%; 95% CI 22-28) patients with at least one PIP per Beers Table S3 (PIP due to drug-disease or drug-syndrome interactions), with the use of corticosteroids in the presence of delirium being the most prevalent criteria (85/205 with delirium; 42%; 95% CI 35-48).…”

Costs associated with adverse drug reactions in an older population admitted to hospital: A prospective cohort study

“…[24] A recent review of tools to help predict and detect ADR in older aged patients (≥ 60 years) identi ed eighteen studies using a variety of tools, but no one de nitive and validated assessment tool for detecting and predicting ADR in elderly patients. [25] Therefore, more research is required to develop validated tools that can be implemented in clinical practice.…”