Reactions In Older Adults Research Articles

Understanding adverse drug reactions in older adults through drug–drug interactions

AimsThe aims of this study are to evaluate prevalence and characteristics of adverse drug reactions (ADRs) and to evaluate the potential contribution of specific medications, therapeutic categories and drug–drug interactions (DDIs) in older adults. MethodsAll ADR reporting forms of persons aged 65+ years collected by the pharmacovigilance of one of the main hospitals in Italy during 2013 were evaluated. DDIs were analysed by a computerized prescription system (INTERCheck) and based on the interactions' database managed by the Istituto di Ricerche Farmacologiche Mario Negri. DDIs were classified according to their clinical relevance as contraindicated, major, and moderate. ResultsAmongst all the ADR reporting forms (n=1014) collected during 2013, 343 affected older adults. The most frequent ADRs were: haemorrhages (n=122, 35.5%), allergic reactions (n=56, 16.3%), and elevated International Normalized Ratio (INR>6, n=54, 15.7%). The specific medications that contributed to ADRs were warfarin (42.5%), acenocumarol (9%), and allopurinol (8.5%); while the therapeutic categories were haematological agents (67%) and proton pump inhibitors (13%). A total of 912 DDIs were found; one third of them were contraindicated or major and 31.5% of them potentially contributed to ADRs; of these, the most frequent were: warfarin and heparin (contraindicated, n=5); warfarin and a statin (major, n=38); warfarin and a proton pump inhibitor (moderate, n=40). At least one DDI contributed to 66 haemorrhages out of 122 (54%) and to 41 elevated INR out of 54 (76%). ConclusionDDIs significantly contribute to the onset of ADRs in older adults and intervention programmes, e.g., the employment of a computerized system, may reduce the burden of iatrogenic illnesses in the elderly.

Characterization of adverse drug reactions in adults over 44 years of age in Bogota, January-December, 2012

In Colombia, aging of the population is a reality and elders consume more drugs than the young do. Consequently, they are more exposed to adverse drug reactions. To characterize suspected adverse drug reactions in adults over 44 years of age in Bogota in 2012. We conducted a pharmacological surveillance study that included 470 reports of adverse drug events and associated problems with the use of drugs in adults over 44 years old included in the database of Bogotá´s pharmacosurveillance program. We evaluated 470 reports of adverse drug events and associated problems with the use of drugs in adults over 44 years of age. From these, 432 reports (91.9%) were classified as suspected adverse drug reactions and 28 (6%), as associated problems with the use of drugs. The incidence rate for adverse drug events reported in Bogotá was 22.5 for every 100,000 elders, which increased in direct proportion to patients´ age. The most frequently reported drug was antibacterials with 94 notifications (20%). The organ system with the highest number of alterations was the skin and annexes with 21.2% of cases. Regarding severity assessment, 69.5% of adverse drug reactions were moderate, and as for causality, most adverse drug reactions were classified as possible, with 45.8% of the reports. The characterization of adverse drug reactions in older adults in Bogotá is similar to that reported in the literature for this population age group.

Caracterización de reacciones adversas a medicamentos en adultos mayores de 44 años en Bogotá, D.C., enero - diciembre de 2012

In Colombia, aging of the population is a reality and elders consume more drugs than the young do. Consequently, they are more exposed to adverse drug reactions.To characterize suspected adverse drug reactions in adults over 44 years of age in Bogota in 2012.We conducted a pharmacological surveillance study that included 470 reports of adverse drug events and associated problems with the use of drugs in adults over 44 years old included in the database of Bogotá´s pharmacosurveillance program.We evaluated 470 reports of adverse drug events and associated problems with the use of drugs in adults over 44 years of age. From these, 432 reports (91.9%) were classified as suspected adverse drug reactions and 28 (6%), as associated problems with the use of drugs. The incidence rate for adverse drug events reported in Bogotá was 22.5 for every 100,000 elders, which increased in direct proportion to patients´ age. The most frequently reported drug was antibacterials with 94 notifications (20%). The organ system with the highest number of alterations was the skin and annexes with 21.2% of cases. Regarding severity assessment, 69.5% of adverse drug reactions were moderate, and as for causality, most adverse drug reactions were classified as possible, with 45.8% of the reports.The characterization of adverse drug reactions in older adults in Bogotá is similar to that reported in the literature for this population age group.

Predicting adverse drug reactions in older adults; a systematic review of the risk prediction models.

Adverse drug reaction (ADR) risk-prediction models for use in older adults have been developed, but it is not clear if they are suitable for use in clinical practice. This systematic review aimed to identify and investigate the quality of validated ADR risk-prediction models for use in older adults. Standard computerized databases, the gray literature, bibliographies, and citations were searched (2012) to identify relevant peer-reviewed studies. Studies that developed and validated an ADR prediction model for use in patients over 65 years old, using a multivariable approach in the design and analysis, were included. Data were extracted and their quality assessed by independent reviewers using a standard approach. Of the 13,423 titles identified, only 549 were associated with adverse outcomes of medicines use. Four met the inclusion criteria. All were conducted in inpatient cohorts in Western Europe. None of the models satisfied the four key stages in the creation of a quality risk prediction model; development and validation were completed, but impact and implementation were not assessed. Model performance was modest; area under the receiver operator curve ranged from 0.623 to 0.73. Study quality was difficult to assess due to poor reporting, but inappropriate methods were apparent. Further work needs to be conducted concerning the existing models to enable the development of a robust ADR risk-prediction model that is externally validated, with practical design and good performance. Only then can implementation and impact be assessed with the aim of generating a model of high enough quality to be considered for use in clinical care to prioritize older people at high risk of suffering an ADR.

Novel safety floors do not influence early compensatory balance reactions in older adults

Novel safety flooring systems are a promising approach for reducing fall-related injuries in seniors, as they have been demonstrated to substantially reduce impact severity during falls, while minimally impairing balance control in community-dwelling older women. This pilot study aimed to characterize the potential effects of flooring conditions on dynamic balance control in retirement home-dwellers with more limited mobility. A tether-release paradigm was used to simulate a trip-type perturbation in 15 seniors across five flooring surfaces (three novel safety floors and one carpet compared to institutional-grade resilient rolled-sheeting). Kinetic and kinematic data tracked the displacement profiles of the underfoot centre-of-pressure and whole-body centre-of-mass, which were used to characterize compensatory balance reactions. Difference tests (ANOVA) found that the onset of the compensatory balance reaction was not associated with floor condition, nor were the timing and magnitude of peak centre-of-pressure excursion (minimum margin of safety) and velocity. Accordingly, the minimum margin of safety of the centre-of-mass was not significantly different across floors. Equivalence tests supported these findings. This study provides evidence that the carpet and novel safety floors tested do not negatively influence characteristics of initial dynamic balance responses following a lean-and-release perturbation compared to an institutional-grade resilient rolled-sheeting surface. In combination with reports of substantial force attenuative properties during fall-related impacts, these findings support the promise of novel safety floors as a biomechanically effective strategy for reducing fall-related injuries.

Transferring control to others: process and meaning for older adults in assisted living.

This study examines qualitative data describing transfers of control over life tasks (e.g., managing money, overseeing care) to close others in terms of the control by and outcome for the older person. The extant caregiving literature includes limited focus on how such task transfers occur, who controls them, and the reactions of older adults. The literature on control, however, provides extensive data that declining control has negative outcomes. Employing data from interviews with 77 adults in assisted living settings, narratives were identified where task transfers were discussed. These 26 instances were reviewed by the authors and categorized as chosen or not chosen by the older adult and their reactions categorized as positive, negative or neutral; if the initial narrative segment was ambiguous, further reading of the informant's interview or that of a family member were added to better understand these cases. Findings show that chosen transfers of tasks to children or others were linked with a positive reaction in all instances identified, while a majority of cases where tasks were taken over by others, the reactions were negative. While literature suggests that declining control is linked to negative outcomes, our findings suggest that the process involved when tasks are transfer to others (delegated or taken by them) may be an important, under-investigated element with potential implications for future research and practice.

Antidepressant adverse drug reactions in older adults: Implications for RNs and APNs

The purpose of this article is to review essential information about the pharmacokinetics of antidepressants in older adults and possible adverse drug reactions associated with each antidepressant class to avoid or minimize adverse drug events.

Serious Adverse Drug Reactions in Older Adults Notified to Pharmacovigilance

PurposeTo report the serious adverse drug reactions (ADRs) in older adults notified to pharmacovigilance, to identify the incriminated drugs and to search for risk factors of occurrence. MethodsA retrospective study including 106 serious adverse drug reactions notified to pharmacovigilance in patients aged of 65 years and more, over a period of 16 years. Imputation was established according to the French method and seriousness according to the World Health Organisation (WHO) criteria. ResultsAdverse drug reactions were essentially systemic. Incriminated drugs were mainly antibiotics, allopurinol and cardio-vascular drugs. Gender, age and number of administered drugs did not seem to be risk factors of serious ADRs occurrence. Among older adults, 4% died further to a serious ADRs. ConclusionSystemic notification to pharma covigilance will allow a better analysis of risk factors of serious ADRs occurrence and to insure safety and health to the older adults.

Adverse Drug Reactions in Older Adults: a Retrospective Study from Pharmacovigilance

PurposeTo assess the adverse drug reactions notified in older adults to pharmacovigilance and to identify the incriminated drugs in their genesis. MethodsA retrospective study including 688 notifications of adverse drug reactions to pharmacovigilance in patients aged of 65 years and more, over a period of 16 years and where the responsibility of one drug or more was incriminated in the genesis of the adverse reaction. Imputation was established according to the French method and seriousness according to the World Health Organization (WHO) criteria. ResultsSex-ratio W/M was 1.2. Average age was 71.3 years. The average number of administered drugs was 3.64 and polymedication was noted in 30% of cases. Adverse drug reactions were essentially cutaneous and systemic. Incriminated drugs were mainly antibiotics and cardio-vascular drugs. Serious adverse drug reactions were noted in 26%. ConclusionIn older adults, adverse drug reactions’ notification to pharmacovigilance is necessary and allows assessing large scale epidemiologic studies to identify iatrogenic risk factors.

Geriatric Conditions and the Risk of Adverse Drug Reactions in Older Adults

While polypathology and polypharmacy are well known risk factors for adverse drug reactions (ADRs), the association between geriatric conditions (GCs), i.e. a set of clinical and functional problems partly constitutive of and partly related to frailty, and ADRs is suspected but has not been fully elucidated. Several studies have assessed the relationship between single GCs and ADRs, but only a few studies have systematically evaluated the relationship between the whole spectrum of GCs and ADRs. The mechanism by which select GCs increase the risk of developing ADRs during a hospital stay might simply reflect a sort of general predictability of physical disability with respect to adverse outcomes. However, GCs pertaining to the physical dimension of frailty are generally associated with relevant changes in pharmacokinetics and pharmacodynamics of select drugs. While current evidence could not be considered either unequivocal or conclusive, select GCs, e.g. a history of falls and loss of independence in the activities of daily living, seem to define a condition of particular vulnerability of elderly patients to ADRs.

What Types of Inappropriate Prescribing Predict Adverse Drug Reactions in Older Adults?

Adverse drug events happen all too often in older adults, but we still do not have a clear understanding of potentially modifiable risk factors, with the exception of polypharmacy. This paper critiques the article in this issue of The Annals entitled, "Inappropriate Prescribing Predicts Adverse Drug Events in Older Adults." A validated measure for self-reported adverse drug events was used, along with a modified measure for inappropriate prescribing that we developed nearly 2 decades ago (ie, Medication Appropriateness Index). Besides discussing the strengths and weaknesses of this article, we also recommend future research directions in this area.

Effect of a Perturbation-Based Balance Training Program on Compensatory Stepping and Grasping Reactions in Older Adults: A Randomized Controlled Trial

Compensatory stepping and grasping reactions are prevalent responses to sudden loss of balance and play a critical role in preventing falls. The ability to execute these reactions effectively is impaired in older adults. The purpose of this study was to evaluate a perturbation-based balance training program designed to target specific age-related impairments in compensatory stepping and grasping balance recovery reactions. This was a double-blind randomized controlled trial. The study was conducted at research laboratories in a large urban hospital. Thirty community-dwelling older adults (aged 64-80 years) with a recent history of falls or self-reported instability participated in the study. Participants were randomly assigned to receive either a 6-week perturbation-based (motion platform) balance training program or a 6-week control program involving flexibility and relaxation training. Features of balance reactions targeted by the perturbation-based program were: (1) multi-step reactions, (2) extra lateral steps following anteroposterior perturbations, (3) foot collisions following lateral perturbations, and (4) time to complete grasping reactions. The reactions were evoked during testing by highly unpredictable surface translation and cable pull perturbations, both of which differed from the perturbations used during training. /b> Compared with the control program, the perturbation-based training led to greater reductions in frequency of multi-step reactions and foot collisions that were statistically significant for surface translations but not cable pulls. The perturbation group also showed significantly greater reduction in handrail contact time compared with the control group for cable pulls and a possible trend in this direction for surface translations. Further work is needed to determine whether a maintenance program is needed to retain the training benefits and to assess whether these benefits reduce fall risk in daily life. Perturbation-based training shows promise as an effective intervention to improve the ability of older adults to prevent themselves from falling when they lose their balance.

Gaze Behavior of Older Adults in Responding to Unexpected Loss of Balance while Walking in an Unfamiliar Environment: a Pilot Study

Purpose Rapid reach-to-grasp balance-recovery reactions play a critical role in preventing falls. Recent young-adult studies suggest these reactions may be guided using stored visuo-spatial information from the central field, and that peripheral vision may also play an important role. This study used gaze recordings to examine the visual control of reach-to-grasp reactions in older adults. Methods A motion platform was configured to simulate a “real-life” environment that included a handrail. Subjects performed an activity that required walking to the end of the platform, which was triggered to move suddenly and unexpectedly as they approached the handrail. Twelve healthy older adults (64-79 years old) were tested and compared to 12 healthy young adults (22-30 years old) tested as part of another study. Results Older adults were more than twice as likely as young adults to react to the platform perturbation by grasping the handrail (10/12 versus 4/12), despite being much less likely to visually fixate the handrail after entering the new environment. Grasping errors were remarkably common (5/10 older, 2/4 young), but there was no consistent relationship to the preceding gaze behavior. Conclusion Older adults were highly dependent on using a handrail to recover balance, but commonly failed to direct overt visual attention to the rail after entering the unfamiliar environment. The failure to fixate the rail required the reaching movement to be guided using peripheral vision. Further research is needed to determine whether grasping errors can be prevented via interventions that either attract overt attention to the handrail or improve processing of peripheral-field information.

Comorbidity and repeat admission to hospital for adverse drug reactions in older adults: retrospective cohort study

Objectives To identify factors that predict repeat admission to hospital for adverse drug reactions (ADRs) in older adults.Design Population based retrospective cohort study.Setting All public and private hospitals in Western...

Effect of Competing Attentional Demands on Perturbation-Evoked Stepping Reactions and Associated Gaze Behavior in Young and Older Adults

Rapid stepping reactions are a prevalent response to sudden loss of balance and are thought to play a crucial role in preventing falls. Previous dual-task studies, involving concurrent performance of step reactions and a visuomotor tracking task, indicated that online visual attention was not required to guide the step, even when nearby objects increased demands for accurate foot movement. However, the planning and execution of the step apparently required attentional resources initially allotted to the tracking task. Reallocation of these resources ("attention switching") was delayed in older adults. The present study examined the influence of the competition for attentional resources by comparing trials performed with and without the concurrent task. Unpredictable platform perturbations were used to evoke rapid forward stepping reactions in healthy young and older adults. Challenging obstacles and/or step targets increased demands for accurate foot motion in some trials. A concurrent tracking task was performed in half of the trials. Although participants looked down more frequently in the absence of the tracking task, the ability to clear the obstacle or land on the step target and other spatiotemporal features of the stepping reactions were largely unaffected. There was, however, one notable exception: In older adults, the duration and amplitude of the "anticipatory postural adjustment" that preceded foot lift were reduced in tracking trials, resulting in increased lateral center-of-mass motion. Impaired attention switching apparently compromised the control of lateral stability during stepping reactions in older adults, and may be an important contributor to increased risk of falling.

University of South Carolina School of Medicine.

University of South Carolina School of Medicine.

Sedative-Hypnotic Use of Diphenhydramine in a Rural, Older Adult, Community-Based Cohort: Effects on Cognition

The authors sought to identify patterns and associations of prescription and over-the-counter sedative-hypnotic use in an older, rural, blue-collar, community-based cohort in southwestern Pennsylvania over 10 years. A group of 1,627 individuals age 65 and over were recruited and assessed during 1987-1989 and re-assessed during approximately biennial waves. Data included sleep medications, demographics, depressive symptoms, sleep complaints, and cognitive functioning (Mini-Mental State Exam [MMSE]). At Waves 1 through 5, the mean age of the cohort increased from 73.4 to 80.5 years. Use of prescription sedative-hypnotics (primarily benzodiazepines) increased from 1.8% to 3.1%, and over-the-counter sedative-hypnotic use (primarily diphenhydramine) increased from 0.4% to 7.6%. At Wave 5 (1996-1998), 8.17% of the sample reported using diphenhydramine as a sleep aid. After adjusting for age and sex, diphenhydramine use was associated with higher education and more depressive symptoms, the latter becoming nonsignificant after controlling for initial insomnia. MMSE became significantly associated with diphenhydramine use when 143 subjects with dementia were excluded from the analysis. As the cohort aged, prescription sedative-hypnotic use remained relatively stable, whereas over-the-counter sedative use, principally diphenhydramine, increased substantially. The association of this drug with cognitive impairment in persons without dementia highlights its potential for causing adverse reactions in older adults.