Prevalence of drug interactions in hospitalised elderly patients: a systematic review

Abstract

BackgroundThe prevalence of drug–drug interactions (DDIs) in hospital settings is variable, and elderly patients are considered a high risk population for DDIs. There are no systematic reviews describing the prevalence of DDIs in hospitalised elderly patients.ObjectivesTo assess and summarise the available data on the prevalence of DDIs in hospitalised elderly patients and to describe which drugs, drug classes and drug combinations are most commonly involved in DDIs.Data sourceA systematic electronic literature search was conducted on Medline/PubMed, Embase, Lilacs, SciElo, Web of Science, Cinahl, Scopus, Cochrane, OpenGrey, Capes Thesis Bank, OasisBR, OpenAire and abstracts from scientific events, without limitation on language or period of publication. Study selection was completed on 21 September 2018.Study eligibility criteria, participants and interventionsOriginal observational studies that reported the prevalence of actual or potential DDIs during hospitalisation in patients aged 60 years or older were included. The main outcome measure was prevalence of DDIs and number of DDIs per patient. Subgroup analysis was performed in studies that reported the prevalence of DDIs in geriatric units.Study appraisal and synthesis methodsStudy quality was assessed using the Agency for Healthcare Research and Quality methodological checklist for cross sectional and prevalence studies.Results34 studies were included, involving 9577 patients. The prevalence of DDIs ranged from 8.34% to 100%. In studies conducted in geriatric units, the prevalence ranged from 80.5% to 90.5%. The number of DDIs per patient ranged from 1.2 to 30.6. Single drugs most commonly involved in DDIs were furosemide, captopril, warfarin and dipyrone. Drug classes mostly involved were potassium sparing diuretics and angiotensin converting enzyme inhibitors.LimitationsThe main limitation is the heterogeneity between the included studies that precluded a meta-analysis. Several different methods were used to identify DDIs, majorly, and potential DDIs. Few studies have reported measures to control the quality of the collected data.Conclusions and implications of key findingsThe prevalence of DDIs ranged widely, and the variation may reflect differences in the conditions of the elderly patients and level of attention (or complexity of care), as well as methodological differences, especially the methods and/or software used to identify DDIs.Systematic review registration numberCRD42018096720

Prevalence of Polypharmacy, Hyperpolypharmacy and Potentially Inappropriate Medication Use in Older Adults in India: A Systematic Review and Meta-Analysis

“…The term PIM is defined as medications that have adverse effects and, when used by older adults, may outweigh the clinical advantages of the drug, such as mental and functional decline, adverse drug events, drug interactions, unplanned hospitalization, morbidity, and mortality ( Thomas and Thomas, 2019 ; Xing et al, 2019 ; de Oliveira et al, 2020 ; Weeda et al, 2020 ). Higher-income countries have taken several steps to improve rational prescribing in older adults and have developed evidence-based explicit tools to screen and prevent PIM use in older patients.…”

“…Several systematic reviews and meta-analyses on the prevalence of polypharmacy and PIM use in the older population, using data from developed countries ( Kaufmann et al, 2014 ; Muhlack et al, 2017 ; Liew et al, 2019 ; Thomas and Thomas, 2019 ; Xing et al, 2019 ; Davies et al, 2020 ; de Oliveira et al, 2020 ; Liew et al, 2020 ; Mohamed et al, 2020 ; Weeda et al, 2020 ), indicated a rising trend of inappropriate medication use in the current healthcare system. However, differences in the population, healthcare settings, and medication use process may limit the generalizability of these findings in developing countries, including India.…”

Prevalence of Drug-Drug Interaction in Hospitalized Patient in Basrah City; Southern of Iraq

“…Lower rate of interactions, about 46% and 26% had been seen in other studies [24,25] respectively. The heterogeneity in the results of various studies may reflect differences in the conditions of the included patients and level of care, as well as the various methodology used, especially the software used to identify these DDIs [26].…”

Current Knowledge about Providing Drug–Drug Interaction Services for Patients—A Scoping Review

“…A drugdrug interaction (DDI) can be described as the effect of one medication being changed (enhanced, diminished, or modified) by the presence of another medication when administered simultaneously or successively [9,10]. DDIs are common, with reported prevalence among hospitalized elderly patients ranging from 8 to 100%, and may compromise patient safety [11]. One of the key components to achieving appropriate drug treatment is the access to the needed information for the involved actors, such as prescribers, pharmacists, and patients [12][13][14].…”

“…The management of DDIs is a complex process and it involves risk-benefit assessment of the involved drugs. Clinical Decision Support Systems (CDSSs) in the medication management process are used to improve health care quality and efficiency [7,[10][11][12][13][14][15][16]. A CDSS can support health care professionals, such as physicians and pharmacists, in detecting potential DDIs by linking patient-specific factors and current medications together with a knowledge database.…”