Prevalence, characteristics and predicting risk factors of adverse drug reactions among hospitalized older adults: A systematic review and meta-analysis

Abstract

Background: Occurrence of adverse drug reactions is a major global health problem mostly affecting older adults. Identifying the magnitude and predictors of adverse drug reactions is crucial to developing strategies to mitigate the burden of adverse drug reactions. This study’s objectives were to estimate and compare the prevalences of adverse drug reactions, to characterize them and to identify the predictors among hospitalized older adults. Methods: A comprehensive systematic literature search including both prevalence and risk factors of adverse drug reactions in hospitalized older adults was conducted using PubMed, Scopus and Google Scholar, involving all articles published in English. Descriptive statistics and comparison of means was performed using SPSS version 20.0 and metaprop command was performed in STATA version 13.0. Heterogeneity was assessed using I2 statistic. Results: A total of 18 studies, involving 80,695 participants with a median age of 77 years, were included in this study. The pooled prevalence of adverse drug reaction was 22% (95% confidence interval: 17%, 28%; I2 = 99.23%). Among high-income countries, the prevalence of adverse drug reactions was 29% (95% confidence interval: 16%, 42%) as compared to 19% (95% confidence interval: 14%–25%) in low and middle-income countries ( p value = 0.176). Of the 620 adverse drug reactions categorized, most were type A (89%), which are generally predictable and preventable. Two-thirds (795, 67%) of the adverse drug reactions were probable and most (1194, 69%) were mild or moderate. The majority (60%) of the categorized adverse drug reactions were preventable and less than one-third (31%) were severe. The most consistently reported predictors of adverse drug reactions in hospitalized older patients were medication-related factors, including polypharmacy and potentially inappropriate medications followed by disease-related factors—renal failure, complex comorbidity, heart failure and liver failure. Conclusion: Almost one-quarter of all hospitalized older adults experienced at least one adverse drug reaction during their hospital stay. The majority of the adverse drug reactions were preventable. Medication-related factors were the most consistently reported predictors of adverse drug reactions followed by disease-related factors.

Prevalence, Incidence, and Characteristics of Adverse Drug Reactions Among Older Adults Hospitalized at Mbarara Regional Referral Hospital, Uganda: A Prospective Cohort Study

“…Systematic reviews that involved hospitalized older patients across the globe reported ADR prevalences of 11.5–24%. 12–15 A study conducted in the US and another from Ethiopia as well as a systematic review that included many studies across the world showed that about 10% of hospital admissions worldwide are related to ADRs. 16–18 In the US, approximately 100,000 emergency hospital admissions of older adults were attributed to ADRs every year.…”

“…Previous study in Uganda reported up to half of the general adults experienced ADRs during hospitalization. 40 However, evidence of ADR prevalence and incidence specifically among the elderly inpatient population in low- and middle-income countries 12 including Uganda, more so from prospective cohort studies, is lacking. We, therefore, conducted a study among elderly inpatients at Medical, Oncology, and Surgical Departments at Mbarara Regional Referral Hospital to determine the prevalence and incidence of suspected ADRs.…”

Development and Validation of ‘Prediction of Adverse Drug Reactions in Older Inpatients (PADROI)’ Risk Assessment Tool

“…The details of the systematic review were published elsewhere. 5 Then we included the 15 previously reported risk factors and four more relevant independent variables, as independent variables in our derivational study conducted at MRRH from November 9, 2020 to May 7, 2021. This study, particularly, aimed at determining the risk factors of hospital-acquired ADRs in this group of patients.…”

Predictors of hospital-acquired adverse drug reactions: a cohort of Ugandan older adults

“…The authors conducted a systematic review on predictors of ADRs in hospitalized older adults and the results are published elsewhere [ 4 ]. We included 15 predictors reported by previous studies as independent variables in our observational study.…”

“…The latest systematic review reported a prevalence of ADRs of 22% among hospitalized older adults; 19% for high-income countries and 29% for low-income countries [ 4 ]. In the UK, between 2007/8 and 2014/15, the emergency admissions due to ADRs increased by 53.4%, and the number of bed days that were used due to ADRs also increased by 51.5% over the same period [ 5 ].…”