Factors associated with adverse drug reactions among residents in nursing home
Main Article Content
Keywords
Adverse drug reactions, Risk factors, Elderly, Nursing home, Polypharmacy, Comorbidity
Abstract
Background and aim: Adverse drug reactions (ADRs) are a significant public health concern, especially in the elderly. Factors like multimorbidity, polypharmacy, frailty, and age-related changes in drug metabolism increase variability in drug response and adverse effects. The objectives of this research is to examine the prevalence of ADRs in elderly residents of nursing homes and to identify the most significant risk factors contributing to these events. Material and methods: This was a retrospective, cross-sectional study that reviewed the medical records of 125 residents in two nursing homes. The study population consisted of all residents aged 65 years or older. Resident characteristics included age, gender, clinical diagnoses, number of comorbidities, residents` functional status, and complete medication history were analyzed using general practitioner documentation in residents` records. Relevant clinical information on ADR characteristics was documented through chart over 12 months. Results: The study included 125 residents with a mean age of 76.52 (SD 7.83), the majority of them were women (66%), with polypharmacy of 5 and above (48%). Overall 10% of elderlies took >10 medications (prescribed or over the counter), and 38% took 5-9. In addition, the mean number of chronic comorbid conditions was approximately four. Mean Charlson comorbidity index was 1.7. Residents with higher Charlson Comorbidity Index showed increased risk of ADRs, r=.552, p<.001. We found patients with non-ADRs used less medications (M=3.88, SD=1.56) compared to those with ADSRs (M=7.26, SD=1.27, t(123)=-6.51, p<.001). Cardiovascular, gastrointestinal, and anticoagulant medications were associated to ADRs. Finally using Pearson`s r correlation coefficient we found that there is a significant positive relationship between ADRs and specific drug classes use as well as higher polypharmacy and comorbidity. Conclusion: This study highlights the high prevalence of ADRs among elderly patients, with a positive association to polypharmacy, comorbidities, and specific drug classes use.
References
2. Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014 Jan 1;13(1):57-65. doi: 10.1517/14740338.2013.827660.
3. Morin L, Johnell K, Laroche ML, Fastbom J, Wastesson JW. The epidemiology of polypharmacy in older adults: register-based prospective cohort study. Clin Epidemiol. 2018 Mar 12;289-98. Available from: https://doi.org/10.2147/CLEP.S153458
4. Davies EA, O’Mahony MS. Adverse drug reactions in special populations–the elderly. Br J Clin Pharmacol. 2015 Oct;80(4):796-807. Available from: https://doi.org/10.1111/bcp.12596
5. Gao LU, Maidment I, Matthews FE, Robinson L, Brayne C; Medical Research Council Cognitive Function and Ageing Study. Medication usage change in older people (65+) in England over 20 years: findings from CFAS I and CFAS II. Age Ageing. 2018 Mar 1;47(2):220-5. doi: 10.1093/ageing/afx158.
6. Jambon J, Choukroun C, Roux-Marson C, Viel É, Leguelinel-Blache G. What Is the Medication Iatrogenic Risk in Elderly Outpatients for Chronic Pain? Clin Neuropharmacol. 2022 May 1;45(3):65-71. doi: 10.1097/WNF.0000000000000505
7. Díez R, Cadenas R, Susperregui J, Sahagún AM, Fernández N, García JJ, et al. Potentially inappropriate medication and polypharmacy in nursing home residents: a cross-sectional study. J Clin Med. 2022 Jun 30;11(13):3808. doi: 10.3390/jcm11133808.
8. Charlesworth CJ, Smit E, Lee DS, Alramadhan F, Odden MC. Polypharmacy among adults aged 65 years and older in the United States: 1988–2010. J Gerontol A Biol Sci Med Sci. 2015 Aug 1;70(8):989-95. doi:10.1093/gerona/glv013.
9. Slabaugh SL, Maio V, Templin M, Abouzaid S. Prevalence and risk of polypharmacy among the elderly in an outpatient setting: a retrospective cohort study in the Emilia-Romagna region, Italy. Drugs Aging. 2010 Dec;27:1019-28. Available from: https://doi.org/10.2165/11584990-000000000-00000
10. Dubrall D, Just KS, Schmid M, Stingl JC, Sachs B. Adverse drug reactions in older adults: a retrospective comparative analysis of spontaneous reports to the German Federal Institute for Drugs and Medical Devices. BMC Pharmacol Toxicol. 2020 Dec;21:1-20. doi: 10.1186/s40360-020-0392-9.
11. World Health Organization. Medication safety in polypharmacy. Geneva: World Health Organization; 2019. Available from: https://apps.who.int/iris/rest/bitstreams/1235792/retrieve
12. Wiffen P. Adverse drug reactions in hospital patients – A systematic review of the prospective and retrospective studies. Bandolier. 2002 Jun:1–15.
13. Tangiisuran B, Graham Davies J, Wright JE, Rajkumar C. Adverse drug reactions in a population of hospitalized very elderly patients. Drugs Aging. 2012 Aug;29:669-79. doi: 10.1007/BF03262282.
14. Gurwitz JH, Field TS, Avorn J, McCormick D, Jain S, Eckler M, et al. Incidence and preventability of adverse drug events in nursing homes. Am J Med. 2000 Aug 1;109(2):87-94.
15. Ehrlich JR, Hassan SE, Stagg BC. Prevalence of falls and fall-related outcomes in older adults with self-reported vision impairment. J Am Geriatr Soc. 2019 Feb;67(2):239-45. doi: 10.1111/jgs.15628
16. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987 Jan 1;40(5):373-83.
17. Nickel CH, Ruedinger JM, Messmer AS, Maile S, Peng A, Bodmer M, et al. Drug-related emergency department visits by elderly patients presenting with non-specific complaints. Scand J Trauma Resusc Emerg Med. 2013 Dec;21:15. doi: 10.1186/1757-7241-21-15.
18. Wawruch M, Zikavska M, Wsolova L, Kuzelova M, Kahayova K, Strateny K, et al. Adverse drug reactions related to hospital admission in Slovak elderly patients. Arch Gerontol Geriatr. 2009 Mar 1;48(2):186-90. PMID: 18313773.
19. Cahir C, Bennett K, Teljeur C, Fahey T. Potentially inappropriate prescribing and adverse health outcomes in community dwelling older patients. Br J Clin Pharmacol. 2014 Jan;77(1):201-10. doi: 10.1111/bcp.12161.
20. Shah BM, Hajjar ER. Polypharmacy, adverse drug reactions, and geriatric syndromes. Clin Geriatr Med. 2012 May 1;28(2):173-86. doi: 10.1016/j.cger.2012.01.002.
21. Lavan AH, Gallagher P. Predicting risk of adverse drug reactions in older adults. Ther Adv Drug Saf. 2016 Feb;7(1):11-22. doi:10.1177/2042098615615472
22. Marcum ZA, Amuan ME, Hanlon JT, Aspinall SL, Handler SM, Ruby CM, et al. Prevalence of unplanned hospitalizations caused by adverse drug reactions in older veterans. J Am Geriatr Soc. 2012 Jan;60(1):34-41. doi: 10.1111/j.1532-5415.2011.03772.x.
23. Bourgeois FT, Shannon MW, Valim C, Mandl KD. Adverse drug events in the outpatient setting: an 11-year national analysis. Pharmacoepidemiol Drug Saf. 2010 Sep;19(9):901-10. doi: 10.1002/pds.1984.
24. Huang YT, Steptoe A, Wei L, Zaninotto P. The impact of high-risk medications on mortality risk among older adults with polypharmacy: Evidence from the English Longitudinal Study of Ageing. BMC Med. 2021 Dec;19:1-3. doi: 10.1186/s12916-021-02192-1.
25. Polonia J, Marques J, Lobo M, Vaz I, Oliveira B. Frequency and Impact of Adverse Drug Reactions Induced by Cardiovascular Drugs and Affecting Cardiovascular System: A National 10 years of Surveillance. J Hypertens. 2021 Apr 1;39:e158. doi: 10.1097/01.hjh.0000746120.51486.97.
26. Hilmer SN, McLachlan AJ, Le Couteur DG. Clinical pharmacology in the geriatric patient. Fundam Clin Pharmacol. 2007;21(3):217–30. doi: 10.1111/j.1472-8206.2007.00473.x
27. Alomar MJ. Factors affecting the development of adverse drug reactions (Review article). Saudi Pharm J. 2014;22(2):83–94. doi: 10.1016/j.jsps.2013.02.003
28. Díez R, Cadenas R, Susperregui J, Sahagún AM, Fernández N, García JJ, et al. Drug-related problems and polypharmacy in nursing home residents: a cross-sectional study. Int J Environ Res Public Health. 2022 Apr 4;19(7):4313. doi: 10.3390/ijerph19074313.
29. Alhawassi TM, Krass I, Bajorek BV, Pont LG. A systematic review of the prevalence and risk factors for adverse drug reactions in the elderly in the acute care setting. Clin Interv Aging. 2014 Dec 1;9:2079-86. doi: 10.2147/CIA.S71178.
30. Rankin A, Cadogan CA, Patterson SM, Kerse N, Cardwell CR, Bradley MC, et al. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev. 2018;(9):CD008165.
31. Curtin D, Gallagher P, O’Mahony D. High-risk prescribing and adverse drug reactions in older adults. Age Ageing. 2019;48(4):519–25.
32. Kouladjian O’Donnell L, Gnjidic D, Nahas R, Bell JS, Chen TF, Hilmer SN. Impact of pharmacist-led medication review on polypharmacy in aged care facilities. Drugs Aging. 2019;36(2):115–26.
33. Page AT, Clifford RM, Potter K, Schwartz D, Etherton-Beer CD. The role of education in reducing inappropriate prescribing and polypharmacy in older adults: A systematic review. Drugs Aging. 2016;33(11):889–98.
34. Rieckert A, Trampisch US, Klaaßen-Mielke R, Drewelow E, Esmail A, Johansson T, et al. Effectiveness of structured medication reviews in older adults: A cluster-randomised trial. BMJ. 2020;369:m2610.
35. Zazzara MB, Palmer K, Vetrano DL, Carfì A, Graziano O, Onder G. Sex differences in adverse drug reactions in older people: A narrative review. Eur J Clin Pharmacol. 2021;77:759–68.
36. Buss VH, Shields GE, Kosari S, Naunton M. Gender differences in adverse drug reactions in older adults: A systematic review. J Am Geriatr Soc. 2021;69(1):78–88.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.