Predicting and detecting adverse drug reactions in old age: challenges and opportunities

Mangoni, Arduino A.

doi:10.1517/17425255.2012.665874

Cited by 31 publications

(19 citation statements)

References 24 publications

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“…26,27 Further, polypharmacy has been linked to inappropriate prescribing, 28 low adherence, 29 preventable and unplanned hospitalization, 30 and adverse drug events, 31 all relevant to the development of frailty. This is particularly relevant to older individuals, who are more susceptible to adverse drug reactions, 32 also caused by commonly used medications. 32 Adverse drug reactions could further increase the risk of frailty as they might lead to a prescribing cascade, in which new medications are prescribed to counteract unwanted effects of the initial drug.…”

Section: Discussionmentioning

confidence: 99%

“…This is particularly relevant to older individuals, who are more susceptible to adverse drug reactions, 32 also caused by commonly used medications. 32 Adverse drug reactions could further increase the risk of frailty as they might lead to a prescribing cascade, in which new medications are prescribed to counteract unwanted effects of the initial drug. 28 …”

Section: Discussionmentioning

confidence: 99%

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Polypharmacy Is Associated With Higher Frailty Risk in Older People: An 8-Year Longitudinal Cohort Study

Veronese

Stubbs

Noale

et al. 2017

Journal of the American Medical Directors Association

159

123

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Objective To investigate whether polypharmacy is associated with a higher incidence of frailty in a large cohort of North Americans during 8 years of follow-up. Design Longitudinal study, follow-up of 8 years. Participants A total of 4402 individuals at high risk or having knee osteoarthritis free from frailty at baseline. Measurements Details regarding medication prescription were captured and categorized as 0–3, 4–6, and ≥7. Frailty was defined using the Study of Osteoporotic Fracture index as the presence of ≥2 out of (1) weight loss ≥5% between baseline and the subsequent follow-up visit; (2) inability to do 5 chair stands; and (3) low energy level according to the Study of Osteoporotic Fracture definition. Cox’s regression models calculating a hazard ratio (HR) with 95% confidence intervals (CIs), adjusted for potential confounders, were undertaken. Results During the 8-year follow-up, from 4402 participants at baseline, 361 became frail. Compared with participants taking 0–3 medications, the incidence of frailty was approximately double in those taking 4–6 medications and 6 times higher in people taking ≥7 medications. After adjusting for 11 potential baseline confounders, participants using 4–6 medications had a higher risk of frailty of 55% (HR = 1.55; 95% CI 1.22–1.96; P < .0001), whereas those using more than 7 drugs were at approximately 147% (HR = 2.47; 95% CI 1.78–3.43; P < .0001). Each additional drug used at the baseline increased the risk of frailty at the follow-up of 11% (HR = 1.11; 95% CI 1.07–1.15; P < .0001). Conclusions Polypharmacy is associated with a higher incidence of frailty over 8-year follow-up period. Our data suggest evidence of a dose response relationship. Future research is required to confirm our findings and explore underlying mechanisms.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Polypharmacy Is Associated With Higher Frailty Risk in Older People: An 8-Year Longitudinal Cohort Study

Veronese

Stubbs

Noale

et al. 2017

Journal of the American Medical Directors Association

159

123

View full text Add to dashboard Cite

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“…4. Monitoring the risks of ADRs that occur in the fragmentation of care (eg, increased number of treating doctors and care transitions) experienced by patients (especially older) during their clinical journey [39].…”

Section: Resultsmentioning

confidence: 99%

The role of general practitioner in the study of adverse drug reactions epidemiology in ambulatory care setting

Turabián¹

2019

Arch Community Med Public Health

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Adverse drug reactions (ADRs) cause considerable mortality and morbidity. Its importance becomes greater in relation to the current increase in the use of drugs and multimorbidity. Premarketing studies do not allow a complete knowledge of the safety of a medicine. Many ADRs occurring in the outpatient setting, but there is a signifi cant lack of information regarding the epidemiology of ADRs in this level of health care. Thus, guidance on how to direct attention to effective targets for improvement of medication safety in ambulatory care settings is missing. In this scenario, the general practitioner (GP) is in a rare, special position in the health system, which allows him to combine the clinical tasks of diagnosis and treatment on individuals with epidemiological and public health tasks on communities, including a important role in the study of ADRs's epidemiology. Among the methods aimed at identifying and quantifying the ADRs, in the GP consultation, we have: 1) Data derived from pure clinical observation; 2) Voluntary spontaneous notifi cation systems; 3) Effective local initiatives for improving the collection of reports on ADRs; 4) Careful epidemiological studies, which may include descriptive studies (crosssectional), retrospective (case-control), prospective (cohort), clinical trials, and single-case studies, seasonal variations, longitudinal studies, etc.; 5) Patient reporting of ADRs; 6) The use of algorithms for the diagnostic of ADRs; 7) Intensive telephone surveillance; 8) Collaborative work with Pharmacists working in the community; 9) From the position of the GP (where the entire medical care process begins and ends) the incidence rate of ADRs caused by hospital prescribed drugs can also be observed and collected from discharge of the hospital admissions; And 10) Genetics and electronic health records can go together to identify heritable traits to predisposition to ADRs."The scientifi c purist, who will wait for medical statistics until they are nosologically exact, is no wiser than Horace's rustic waiting for the river to flow away. " Major Greenwood, 1948.

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“…Frailty is associated with an increased risk of emergency department visits and hospitalisation [18]. Frailty may also be associated with increased adverse reactions to medications [19]. Alternatively hospitalisation for new onset heart failure can be followed by sustained functional decline [20].…”

Section: Frailty In Heart Failure Patientsmentioning

confidence: 99%

Heart Failure Pharmacotherapy and Supports in the Elderly - A Short Review

Shakib

Clark²

2016

CCR

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Heart failure is predominantly a disease of the elderly with an increasing prevalence with increasing age. Increasing age is also associated with increased multi-morbidity such that elderly heart failure patients typically have five to six comorbidities in addition to heart failure. Elderly patients are also more likely to have heart failure with preserved ejection fraction (HFpEF), and there are fewer evidence-based treatments with proven efficacy in HFpEF. Hence the management of heart failure in these patients is largely about managing the symptoms of heart failure, along with the other cardiovascular and non-cardiovascular comorbidities. Any proposed treatments need to be considered for the potential for reduced benefit due to the competing risk of morbidity and mortality from the patient’s other conditions. In patients with heart failure, health related quality of life is impacted by both comorbidities and frailty, and frailty is associated with an increased risk of emergency department visits and hospitalisation. Frailty may also be associated with increased adverse reactions to medications. Although newer guidelines have more information on the management of these comorbidities there are still many areas of uncertainty and potential treatment conflicts. Further research is required on the interactions between different comorbidities, their treatments and heart failure and its management.

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Predicting and detecting adverse drug reactions in old age: challenges and opportunities

Cited by 31 publications

References 24 publications

Polypharmacy Is Associated With Higher Frailty Risk in Older People: An 8-Year Longitudinal Cohort Study

Polypharmacy Is Associated With Higher Frailty Risk in Older People: An 8-Year Longitudinal Cohort Study

The role of general practitioner in the study of adverse drug reactions epidemiology in ambulatory care setting

Heart Failure Pharmacotherapy and Supports in the Elderly - A Short Review

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