Abstract
Elderly patients are at a 4-fold higher risk of adverse drug events (ADEs) and drug-related hospitalization. Hospitalization of an elderly patient is often preceded by geriatric syndromes, like falls or delirium. The primary aim of this study was to investigate whether geriatric syndromes were associated with ADEs in acutely admitted elderly patients. Consecutive medical patients, aged 65 years or more, who were acutely admitted, were enrolled. An initial multidisciplinary evaluation was completed and baseline characteristics were collected. A fall before admission was retrieved from medical charts. Delirium was determined by the Confusion Assessment Method. A total of 641 patients were included. Over 25% had an ADE present at admission, 26% presented with delirium and 12% with a fall. Delirium was associated with the use of antidepressants, antipsychotics and antiepileptics. In all ADEs (n = 167), ADEs were associated with a fall, with non-steroidal anti-inflammatory drugs or diuretics, but not with pre-existing functioning, delirium or older age. For ADEs involving psychoactive medication (n = 35), an association was found between delirium, falls, opioids and antipsychotics in bivariate analyses. A fall just before hospitalization (odds ratio [OR] 3.69 [95% CI 1.41, 9.67]), antipsychotics (OR 3.70 [95% CI 1.19, 11.60]) and opioids (OR 14.57 [95% CI 2.02, 105.30]) remained independently associated with an ADE involving psychoactive medication. This prospective study demonstrated that, in a cohort of elderly hospital patients, a fall before admission and prevalent delirium are associated with several pharmacological groups and/or with ADE-related hospital admission.
Highlights
Patients are at a four-fold higher risk of adverse drug events (ADEs) and drug related hospitalization
Over 25% had an ADE present at admission, 26% presented with delirium and 12% with a fall
Geriatric syndromes are understood to have the following features: they occur in older, often vulnerable persons; precipitated by one or more acute triggers, they are multifactorial in aetiology; they seldom follow a typically episodic course and they frequently lead to persistent functional impairment.8;9 An acute illness leading to hospitalization is often accompanied by one or more geriatric syndromes, especially falls and delirium (15–30% and 10%, respectively).[10,11,12,13]
Summary
Patients are at a four-fold higher risk of adverse drug events (ADEs) and drug related hospitalization. ADEs are the most frequent type of adverse events occurring in medical inpatients and a considerable part of hospital admissions are related to ADEs. ADEs have been associated with unnecessary hospital admission.[1] Compared with younger patients, patients aged 65 years or older are at a four-fold higher risk for ADEs.[2] This can be ascribed to their comorbidities, complex care, presence of cognitive, social and functional limitations, use of multiple drugs, and altered pharmacokinetics and pharmacodynamics.3;4 A recent systematic review showed that the odds of being hospitalized by ADE-related problems is four times higher for elderly persons (16.6% vs 4.1%).5Approximately 50% of ADEs are preventable,[4,5] and can be resolved if detected in time. Geriatric syndromes are understood to have the following features: they occur in older, often vulnerable persons; precipitated by one or more acute triggers, they are multifactorial in aetiology; they seldom follow a typically episodic course and they frequently lead to persistent functional impairment.8;9 An acute illness leading to hospitalization is often accompanied by one or more geriatric syndromes, especially falls and delirium (15–30% and 10%, respectively).[10,11,12,13] These geriatric syndromes are associated with substantially poorer discharge outcomes such as functional decline, institutionalization, and mortality.[14]
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