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adverse drug effects in the elderly

Epidemiology: 1) 1/3 of hospitalizations in elderly (includes non-compliance) a) 11% due to non-compliance b) 17% due to drug adverse effect 2) most commonly dermatologic, gastrointestinal, neurologic 3) 1/3 due to allergies, 1/3 due to unintentional overdoses 4) most common culprits a) hypoglycemic agents, opioids, anticoagulants, digoxin, amoxicillin, antihistamines, antiplatelet agents, phenytoin b) most commly implicated medications [3] - warfarin, insulin, aspirin, clopidogrel, digoxin c) 1/3 due to warfarin, insulin, or digoxin 5) ambulatory elderly on average of 4.5 meds 6) institutionalized elderly on average of 7 meds 7) high-risk prescribing practices common [4] 8) many drugs (alone or in combination) increase the risk of falls in the elderly # only digoxin in Beer's criteria

Related

Beers criteria pharmacokinetics in the elderly polypharmacy (unecessary drug prescription)

Specific

drugs commonly producing delirium pharmaceutical agents associated with constipation pharmaceutical causes of urinary incontinence

General

drug adverse effect(s) of geriatric disorder; disease of old age; geriatric syndrome

References

  1. Prescriber's Letter 13(12): 2006 Emergency Department Visit Due to Adverse Drug Events Detail-Document#: 221211 (subscription needed) http://www.prescribersletter.com
  2. Zhan C, Sangl J, Bierman AS, Miller MR, Friedman B, Wickizer SW, Meyer GS. Potentially inappropriate medication use in the community- dwelling elderly: findings from the 1996 Medical Expenditure Panel Survey. JAMA. 2001 Dec 12;286(22):2823-9. PMID: 11735757
  3. Budnitz DS et al, National surveillance of emergency department visits for outpatient adverse drug events. JAMA 2006, 296:1858 PMID: 17047216 - Budnitz DS et al, Medication use leading to emergency department visits for adverse drug events in older adults. Ann Intern Med 2007, 147:755 PMID: 18056659
  4. Guthrie B et al. High risk prescribing in primary care patients particularly vulnerable to adverse drug events: Cross sectional population database analysis in Scottish general practice. BMJ 2011 Jun 21; 342:d3514 PMID: 21693525