Medication misadventures in the elderly: A year in review

Abstract

Objective: This paper reviews recent articles examining medication misadventures that can be defined as medication errors and adverse drug events in the elderly. Methods: MEDLINE and International Pharmaceutical Abstracts were searched for articles published in English in 2009 using a combination of the terms medication errors, medication adherence, suboptimal prescribing, monitoring, adverse drug events, adverse drug withdrawal events, therapeutic failure, and aged. A manual search of the reference lists of the identified articles and the authors' article files, book chapters, and recent reviews was conducted to identify additional publications. Those studies that described unique approaches to evaluating medication misadventures in the elderly were included in the review. Results: The search identified 5 unique studies relating to medication misadventures in the elderly. A crosssectional study found that a new 8-item paper-and-pencil adherence survey—the Morisky Medication Adherence Scale—was significantly associated with antihypertensive drug pharmacy refill adherence ( P < 0.05). A cross-sectional study of medication discrepancies that occurred during transition from the hospital to a nursing home found discrepancies in almost 75% of patients. A randomized controlled trial of a computer-generated decision support intervention to reduce potentially inappropriate prescribing in an emergency department found that the intervention was associated with a significant reduction in prescriptions for such medications ( P = 0.02). One study found that patients who were taking digoxin and had been hospitalized during the previous 2 months were at significantly increased risk for additional hospitalizations due to digoxin toxicity. A survey study of Medicare beneficiaries found that use of multiple types of inappropriate medications was a risk factor for self-reported adverse drug events, independent of the number of medications taken. Conclusion: Data from these recently published studies could be used to guide the development and evaluation of quality improvement, research, or clinical practice initiatives.