adverse drug effects in the elderly

^[1]^[2]^[3]^[4]

Epidemiology

1/3 of hospitalizations in elderly (includes non-compliance)
- 11% due to non-compliance
- 17% due to drug adverse effect
most commonly dermatologic, gastrointestinal, neurologic
1/3 due to allergies, 1/3 due to unintentional overdoses
most common culprits
- hypoglycemic agents, opioids, anticoagulants, digoxin, amoxicillin, antihistamines, antiplatelet agents, phenytoin
- most commly implicated medications^[3]
  - warfarin, insulin, aspirin, clopidogrel, digoxin
- 1/3 due to warfarin, insulin, or digoxin
ambulatory elderly on average of 4.5 meds
institutionalized elderly on average of 7 meds
high-risk prescribing practices common^[4]
many drugs (alone or in combination) increase the risk of falls in the elderly

↑ Prescriber's Letter 13(12): 2006 Emergency Department Visit Due to Adverse Drug Events Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=221211&pb=PRL (subscription needed) http://www.prescribersletter.com
↑ Zhan C, Sangl J, Bierman AS, Miller MR, Friedman B, Wickizer SW, Meyer GS. Potentially inappropriate medication use in the community- dwelling elderly: findings from the 1996 Medical Expenditure Panel Survey. JAMA. 2001 Dec 12;286(22):2823-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/11735757
↑ ^3.0 ^3.1 Budnitz DS et al, National surveillance of emergency department visits for outpatient adverse drug events. JAMA 2006, 296:1858 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17047216
Budnitz DS et al, Medication use leading to emergency department visits for adverse drug events in older adults. Ann Intern Med 2007, 147:755 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18056659
↑ ^4.0 ^4.1 Guthrie B et al. High risk prescribing in primary care patients particularly vulnerable to adverse drug events: Cross sectional population database analysis in Scottish general practice. BMJ 2011 Jun 21; 342:d3514 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21693525