Nibu Parameswaran Nair1, Leanne Chalmers2, Bonnie J Bereznicki2, Colin Curtain2, Gregory M Peterson2, Michael Connolly2,3, Luke R Bereznicki2. 1. Unit for Medication Outcomes Research and Education, Division of Pharmacy, Faculty of Health, School of Medicine, University of Tasmania, Hobart, TAS, 7001, Australia. Nibu.ParameswaranNair@utas.edu.au. 2. Unit for Medication Outcomes Research and Education, Division of Pharmacy, Faculty of Health, School of Medicine, University of Tasmania, Hobart, TAS, 7001, Australia. 3. Royal Hobart Hospital, Hobart, TAS, Australia.
Abstract
INTRODUCTION: Adverse drug reactions (ADRs) have been commonly cited as a major cause of hospital admissions in older individuals. However, despite the apparent magnitude of this problem, there are limited prospective data on ADRs as a cause of hospitalization in elderly medical patients. OBJECTIVES: The objective of this study was to evaluate the proportion, clinical characteristics, causality, severity, preventability, and outcome of ADR-related admissions in older patients admitted to two Tasmanian hospitals. METHODS: We conducted a prospective cross-sectional study at the Royal Hobart and Launceston General Hospitals in Tasmania, Australia. A convenience sample of patients, aged 65 years and older, undergoing unplanned overnight medical admissions was screened. ADR-related admissions were determined through expert consensus from detailed review of medical records and patient interviews. The causality, preventability and severity of each ADR-related admission were assessed. RESULTS: Of 1008 admissions, the proportion of potential ADR-related medical admissions was 18.9%. Most (88.5%) ADR-related admissions were considered preventable. Cardiovascular complaints (29.3%) represented the most common ADRs, followed by neuropsychiatric (20.0%) and renal and genitourinary disorders (15.2%). The most frequently implicated drug classes were diuretics (23.9%), agents acting on the renin angiotensin system (16.4%), β-blocking agents (7.1%), antidepressants (6.9%), and antithrombotic agents (6.9%). Application of the Naranjo algorithm found 5.8% definite, 70.1% probable, and 24.1% possible ADRs. ADR severity was rated moderate and severe in 97.9% and 2.1% of admissions, respectively. For most (93.2%) ADR-related admissions the ADR resolved and the patient recovered. CONCLUSION: Hospitalization due to an ADR is a common occurrence in this older population. There is need for future studies to implement and evaluate interventions to reduce the risk of ADR-related admissions in elderly populations.
INTRODUCTION: Adverse drug reactions (ADRs) have been commonly cited as a major cause of hospital admissions in older individuals. However, despite the apparent magnitude of this problem, there are limited prospective data on ADRs as a cause of hospitalization in elderly medical patients. OBJECTIVES: The objective of this study was to evaluate the proportion, clinical characteristics, causality, severity, preventability, and outcome of ADR-related admissions in older patients admitted to two Tasmanian hospitals. METHODS: We conducted a prospective cross-sectional study at the Royal Hobart and Launceston General Hospitals in Tasmania, Australia. A convenience sample of patients, aged 65 years and older, undergoing unplanned overnight medical admissions was screened. ADR-related admissions were determined through expert consensus from detailed review of medical records and patient interviews. The causality, preventability and severity of each ADR-related admission were assessed. RESULTS: Of 1008 admissions, the proportion of potential ADR-related medical admissions was 18.9%. Most (88.5%) ADR-related admissions were considered preventable. Cardiovascular complaints (29.3%) represented the most common ADRs, followed by neuropsychiatric (20.0%) and renal and genitourinary disorders (15.2%). The most frequently implicated drug classes were diuretics (23.9%), agents acting on the renin angiotensin system (16.4%), β-blocking agents (7.1%), antidepressants (6.9%), and antithrombotic agents (6.9%). Application of the Naranjo algorithm found 5.8% definite, 70.1% probable, and 24.1% possible ADRs. ADR severity was rated moderate and severe in 97.9% and 2.1% of admissions, respectively. For most (93.2%) ADR-related admissions the ADR resolved and the patient recovered. CONCLUSION: Hospitalization due to an ADR is a common occurrence in this older population. There is need for future studies to implement and evaluate interventions to reduce the risk of ADR-related admissions in elderly populations.
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