Adverse Drug Events in Older Adults

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Older adults are at higher risk of adverse drug events because of age-related decline in kidney and liver function and use of multiple medications. The U. S. Food and Drug Administration requires pharmaceutical manufacturers to include a boxed warning "black box" on medications that present especially significant risks. A list of medications that require black box warnings can be found on this Web site.

A drug burden index to define the functional burden of medications in older people

Hilmer and colleagues developed a tool (drug burden index) to correlate medication use with decline in physical and cognitive performance. Medications with anticholinergic and sedative properties are associated with poorer function in community-dwelling older people.

Link to abstract.

Hilmer SN, et al. Arch Intern Med. 2007;167:781-787.

Medication use leading to emergency department visits for adverse drug events in older adults

 

A nationally representative public health surveillance system tracked emergency department visits, and visits related to adverse drug events in older adults were analyzed. Three medications accounted for one-third of all emergency department visits for adverse drug events in older adults.

Link to abstract.

Budnitz DS, Shehab N, Kegler SR, Richards CL. Ann Intern Med. 2007;147:755-765.

Adverse drug events among older persons in the ambulatory setting

Multiple methods were used to detect possible drug-related events in this cohort study of an ambulatory Medicare population, with over 30,000 person-years of observation. The overall rate of adverse drug events was 50.1 per 1000 person-years, with 38% categorized as serious, life-threatening, or fatal. Cardiovascular medications, diuretics, and nonopioid analgesics were the most common medication categories associated with preventable adverse drug events. The article provides more extensive information about other types of adverse drug events and strategies for prevention.

Link to abstract.

Gurwitz JH, et al. JAMA. 2003;289:1107-1116.

Adverse drug events in nursing homes

Handler, SM, Wright RM, Ruby CM, Hanlon JT. The epidemiology of medication-related adverse events in nursing homes.  Am J Geriatr Pharmacother 2006:4:264-272.

Link to abstract.

Handler SM, Hanlon JT. Detecting Adverse Drug Events Using a Nursing Home Specific Trigger Tool.  Ann Long-Term Care 2010;18(5):17-22.

Link to abstract.

Ten key articles in geriatric pharmacotherapy
This document provides an overview of ten key articles (PDF) that would be useful for any geriatric clinician.

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