The Epidemiology of Serious Adverse Drug Reactions Among the Elderly

Abstract

Although the incidence and prevalence of serious adverse drug reactions (ADRs) in the elderly cannot be accurately stated, published estimates appear to be unchanged since the earliest reports in the 1960s. Whereas heightened awareness of the problem may weigh in favour of a reduction in ADR frequency, the dramatic increase in the number and availability of therapeutic agents has undoubtedly contributed to the observed high proportion of drug-induced morbidity among acute geriatric hospital admissions. No single drug or drug class is of particular concern since none appears to cause serious morbidity out of proportion with its use. Although numerous studies have sought to identify risk factors for ADRs, the only truly independent predictor is the absolute number of concurrently used medications. However, other studies indicate that there is poor doctor-patient agreement regarding a patient's drug regimen, and interventions that aim to reduce the incidence of ADRs have failed to demonstrate a positive effect. Thus at present the most rational approach would appear to be to establish an accurate knowledge of the patients drug regimens: once this is known one can attempt to rationally minimise the number of medications without compromising therapeutic goals.

Patterns, Predictors and Outcomes of Polypharmacy among Elderly Perioperative Patients in the General Surgical Department of a Tertiary Care Teaching Hospital

“…This is possibly because our institution is a tertiary care referral centre, having in-house round the clock experienced surgeons and physician to analyse the risk situations for an ADR and appropriately prescribed medications thereby mitigating an ADR. There have been studies, which show that a good communication between the patient and his doctor would do good in avoiding ADR be it in the hospital or community [19] . A good doctor patient communication is achieved by the mere availability of doctors like in our setting.…”

Prescribing appropriately in frail older people

“…The number of different drugs a person takes is the single most important predictor of inappropriate prescribing and ADEs. One report estimated the risk of ADEs as 13% for two drugs, 38% for four drugs and 82% for seven drugs or more [41].…”

Concomitant prescription of psychotropic and cardiovascular drugs in elderly patients

“…The incidence of adverse drug outcomes from using these drugs is also highest in this population. Ageing itself is not a risk factor for adverse drug reactions [1]. However, age-related physiologic changes may alter the pharmacokinetic and pharmacodynamic effects of drugs.…”

“…The most common causative drugs for adverse outcomes in the elderly are cardiovascular drugs and psychotropic drugs [1,2]. Several epidemiological studies indicate that the most common prescription drugs among persons aged 70 years or over are also cardiovascular drugs followed by psychotropic drugs [3,4].…”