Adverse Drug Events In Older People Research Articles

Pharmacist-led interventions to reduce adverse drug events in older people living in residential aged care facilities: A systematic review.

We aimed to investigate the efficacy and effectiveness of pharmacist-led interventions to reduce adverse drug events (ADEs) in older people living in residential aged care facilities (RACFs). We systematically searched MEDLINE via PubMed, Embase, Cochrane Central Register of Controlled Trials and PsycINFO from their inceptions to July 2020. We investigated experimental study designs that employed a control group, or quasi-experimental studies conducted in RACFs. We screened 3826 records and included 23 studies. We found seven single-component and 16 multicomponent pharmacist-led interventions to reduce ADEs in older people living in RACFs. The most frequent single-component pharmacist-led intervention was medication review. Medication review and education provision to healthcare professionals were the most common components in many pharmacist-led multicomponent interventions. Thirteen studies (56%) showed no effect, whereas ten studies (43%) reported significant reductions in ADEs following pharmacist-led interventions either as a sole intervention or as a part of a multi-component intervention. Many interventions focused on reducing the incidence of falls (39%). This systematic review suggests that pharmacist-led interventions have the potential to reduce the incidence of ADEs in older people living in RACFs. Medication review and educational programmes, particularly academic detailing, either as a single component or as part of multicomponent interventions were the most common approaches to reducing drug-related harm in older people living in RACFs. The lack of a positive association between interventions and ADE in many studies suggests that targeted and tailored pharmacist-led interventions are required to reduce ADEs in older people in RACFs.

The Economic Burden of Inappropriate Drug Prescribing, Lack of Adherence and Compliance, Adverse Drug Events in Older People

Adverse drug events (ADEs) are an increasingly relevant issue for healthcare systems as they are associated with poorer health outcomes and avoidable misuse of resources. The rates of ADEs are higher in the elderly population, as many older patients have comorbidities, multiple drug prescriptions and deteriorated physical and cognitive functioning. The occurrence of ADEs can lead to a perceived lack of therapy efficacy and further underuse or suboptimal adherence in elderly people, with detrimental clinical outcomes. The present article systematically reviews the studies evaluating the economic impact of ADEs occurring as consequence of poor therapy adherence, inappropriate drug use, underuse of effective treatments and poor adherence, medication errors, drug-drug and drug-disease interactions.A Medline systematic literature review of studies evaluating the economic consequences of inappropriate drug prescribing, lack of adherence and compliance, ADEs in older people was performed. English-language articles were screened through a three-step approach (title review, abstract review, full article review) to select pertinent studies quantitatively evaluating costs. We systematically reviewed evidence from767 articles. After title, abstract and full text review, 21 articles were found to measure economic implications ofADEs, inappropriate drug prescribing and poor adherence in elderly patients. Studies suggested that the economic impact of these undesired effects is substantial: hospital costs were the main cost driver, with a relevant part of them being preventable (consequences of inappropriate prescribing). Healthcare costs for unused drug wastage and destruction were also surprisingly high.Although economic evidence in elderly patients is still limited, all studies seemed to confirm that the financial burden due to pharmacological treatment issues is relevant in elderly people. Including economic effects of adverse events in pharmacoeconomic analysis would be beneficial to improve the reliability of results. Preliminary evidence suggests that programmes aimed at comprehensively assessing geriatric conditions, detecting 'high-risk' prescriptions and training patients to comply with prescribed therapies could be costeffective measures to reduce the burden of ADEs.

The Silver Tsunami is Coming: Will Pharmacy Be Swept Away with the Tide?

It's been called the silver tsunami, the age wave, the geriatric imperative, among others. It is the aging baby boomers and the first of this cohort turns 65 years old in 2011. From a health care perspective, the numbers are scary. Seventy-six million boomers will enter the fragmented, under funded health care arena for older people. Today the elderly constitute 12% of the US population and use approximately 35% of all medications. Medication use will likely grow with increased use of multiple medications to treat illnesses and increase longevity. Over the next 20 years, 1 in every 5 Americans will be over 65 years of age, and even more important, the 85-plus cohort will expand to 15 million over the next 40 years—about the same length of time that our recent graduates will be in practice. This raises the question: Are our graduates able to provide excellent care to the ever increasing older population? Older people, particularly those more than 85 years old, utilize massive healthcare dollars, have the poorest outcomes from adverse drug events (ADEs), and often receive inadequate, inappropriate, or poorly managed medication therapy. The incidence of avoidable adverse outcomes from drug therapy in older people is shameful. For example, 28% of ADEs in ambulatory geriatric patients are deemed preventable; even more shocking, 50% of the life-threatening and fatal ADEs are preventable.1 Why aren't they being prevented? Who's responsible for prevention? The main causes of these preventable ADEs include prescribing inappropriate medications, wrong dosing, and inferior monitoring. Poor patient adherence and lack of patient education account for more than 20% of preventable ADEs1—clearly a pharmacist intervention opportunity. In older adults the incidence of emergency department visits as a consequence of ADEs increases with age and accounts for 25% of all ADE-related emergency department visits.2 Improper therapeutic monitoring is a major cause for these visits, and approximately 50% of seniors with drug-related emergency department visits are hospitalized as a result of their ADE, highlighting the vulnerability of older people using medications.2 Given these and other alarming data, what is going to happen over the next 20 years when our population is 20% geriatric? Will pharmacists be on the front lines rendering better care in the future than what is currently being provided? The Institute of Medicine's 2008 report, Retooling for an Aging America: Building the Health Care Workforce, makes the case that “the geriatric competence of virtually all members of the health care workforce needs to be improved through significant enhancements in the educational curricula and training programs.”3 Like most health disciplines, pharmacy education is woefully inadequate in geriatrics. Few US colleges and schools of pharmacy mandate a geriatric-focused advanced practice experience, although most schools offer this as an elective.4,5 In addition, few pharmacy schools have a required geriatrics course or module and integrate geriatrics into other coursework.4,5 The quantity and success of integration is unknown, but less than half of all schools of pharmacy have a full-time geriatric pharmacy specialist.5 Geriatric pharmacy practice is much more than applying pharmacokinetic principles based on age-related altered renal function. Although this is important, age-related changes in pharmacodynamics are far more important, as these changes extensively contribute to the unnecessary high rate of ADEs in older people. There are geriatric pharmacotherapy doctrines that all pharmacists must know. But other nonpharmacologic knowledge and competencies must be learned by our students, including overcoming communication barriers that are frequently encountered in geriatrics; being able to work with community-based aging networks; working within social and economic constraints; continuum of care issues; and geriatric assessment to recognize common but unusual presentations of ADEs and geriatric syndromes. Our students must develop good interpersonal skills to work with other care providers, as the practice of geriatric medicine is interdisciplinary. Now is the time for faculties to assess their curriculum to determine whether they are adequately preparing their graduates for the silver tsunami. With the number of older people in the United States almost doubling to 70 million by 2030, if we don't address the shortfall in geriatric education today, pharmacists will not be part of interdisciplinary teams caring for seniors. As all health disciplines will not have sufficient numbers to care for our growing elderly population, we have an opportunity to fill a void by having pharmacists be responsible for medication therapy management in seniors. It won't be easy, as we do not have sufficient numbers of pharmacists with specialized training in geriatrics to serve as faculty. The academy must work towards funding more postdoctoral training programs and mid-career develop awards and help retool practicing pharmacists to meet the demand that will soon be upon us. The profession of pharmacy will suffer greatly if we wait too long to improve geriatric pharmacy education. If we don't prepare for the silver tsunami, we will be swept away with the tide.

Inappropriate prescribing and adverse drug events in older people

Inappropriate prescribing (IP) in older patients is highly prevalent and is associated with an increased risk of adverse drug events (ADEs), morbidity, mortality and healthcare utilisation. Consequently, IP is a major safety concern and with changing population demographics, it is likely to become even more prevalent in the future. IP can be detected using explicit or implicit prescribing indicators. Theoretically, the routine clinical application of these IP criteria could represent an inexpensive and time efficient method to optimise prescribing practice. However, IP criteria must be sensitive, specific, have good inter-rater reliability and incorporate those medications most commonly associated with ADEs in older people. To be clinically relevant, use of prescribing appropriateness tools must translate into positive patient outcomes, such as reduced rates of ADEs. To accurately measure these outcomes, a reliable method of assessing the relationship between the administration of a drug and an adverse clinical event is required. The Naranjo criteria are the most widely used tool for assessing ADE causality, however, they are often difficult to interpret in the context of older patients. ADE causality criteria that allow for the multiple co-morbidities and prescribed medications in older people are required. Ultimately, the current high prevalence of IP and ADEs is unacceptable. IP screening criteria need to be tested as an intervention to assess their impact on the incidence of ADEs in vulnerable older patients. There is a role for IP screening tools in everyday clinical practice. These should enhance, not replace good clinical judgement, which in turn should be based on sound pharmacogeriatric training.