Abstract
PurposeThe purpose of the study is to identify and explore risk factors of serious adverse drug events (SADE) and SADE-related admissions in acutely hospitalized multimorbid older adults and assess whether these could have been prevented by adherence to the prescription tools Screening Tool of Older Persons’ Prescriptions (STOPP) and The Norwegian General Practice (NORGEP) criteria.MethodsCross-sectional study of acutely admitted patients to a medical department in a Norwegian regional hospital. Eligible patients were community-dwelling, receiving home care services, and aged 75+, with ≥ 3 chronic diseases. Medications and information regarding the admission were retrieved from the referral letter and medical records, while an expert panel identified SADE using the Common Terminology Criteria for Adverse Events and SADE-related admissions.ResultsWe included 232 patients. Mean (SD) age was 86 (5.7) years, 137 (59%) were female, 121 (52%) used 5–9 drugs whereas 65 (28%) used ≥ 10. We identified SADEs in 72 (31%) of the patients, and in 49 (68%) of these cases, the SADE was considered to cause the hospital admission. A low body mass index (BMI) and a high Cumulative Illness Rating Scale-Geriatrics (CIRS-G) score were independent risk factors for SADEs. Among the SADEs identified, 32 (44%) and 11 (15%) were preventable by adherence to STOPP and NORGEP, respectively.ConclusionsWe found a high prevalence of SADE leading to hospitalization. Risk factors for SADE were high CIRS-G and low BMI. STOPP identified more SADEs than NORGEP, but adherence to the prescription tools could only to a limited degree prevent SADEs in this patient group.
Highlights
Polypharmacy is frequent in aged populations [1,2,3] and increases the risk of inappropriate prescribing [4] and adverse drug events (ADE) in old frail people [5]
The aims of this study were to identify serious adverse drug events (SADEs) in a multimorbid population of older adults acutely admitted to hospital, to assess whether the SADEs caused the admission, to explore risk factors for such events, and to assess whether the SADEs could have been prevented by adherence to the prescription guidelines Screening Tool of Older Persons’ Prescriptions (STOPP) or Norwegian General Practice (NORGEP)
If we found any reason to believe that the symptom at stake could be caused by a disease rather than a drug event, it was excluded from the SADE list
Summary
Polypharmacy is frequent in aged populations [1,2,3] and increases the risk of inappropriate prescribing [4] and adverse drug events (ADE) in old frail people [5]. Older patients with polypharmacy and inappropriate medications are more prone to acute hospitalization [6]. ADEs in older people can be difficult to identify. Unspecific symptoms like falls, delirium, urinary incontinence, and functional decline are frequent reasons for hospital admission. Several studies have estimated the prevalence of hospital admissions due to ADEs, but their quality varies. Another systematic review of observational studies reported a prevalence rate of ADE of up to 11% in older adults [10]
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