Tips to prevent adverse drug events in older adults

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Public release date: 2-Jan-2008

http://www.eurekalert.org/pub_releases/2008-01/tuhs-ttp010208.php

Contact: Siobhan Gallagher

siobhan.gallagher@...

Tufts University, Health Sciences

Tips to prevent adverse drug events in older adults

BOSTON (January 2, 2008) Adverse drug events are more common in older

adults because they are prescribed more drugs and are effected

differently by these drugs than their younger counterparts. A review

article written by Tufts University School of Medicine clinicians,

published in American Family Physician, summarizes steps that physicians

and other healthcare providers can take to avoid overuse, misuse, and

underuse of medication in older adults.

“About one in three older persons taking at least five medications will

experience an adverse drug event each year, and about two-thirds of

these patients will require medical attention. Approximately 95 percent

of these reactions are predictable, and about 28 percent are

preventable,” cite the authors, Cung Pham, MD, fellow in the Tufts

University Family Medicine Residency at Cambridge Health Alliance’s

Malden Family Medicine Center, and Dickman, MD, Jaharis Family

Chair of Family Medicine at Tufts University School of Medicine.

Pham and Dickman summarize interventions for reducing inappropriate

prescriptions as follows, while noting that there is limited research to

support clear interventions.

--Avoiding misuse of medications

If a drug is listed on the Beers Criteria, a widely-adopted list of

drugs that labels medications as “potentially inappropriate” for older

persons or for older persons with specific medical conditions, the

authors report that physicians can avoid those drugs apt to cause a

severe adverse drug event simply by selecting alternatives. If there is

no alternative, the best choice for a necessary drug is to start at the

lowest effective dose and, when possible, discontinue the drug.

--Avoiding overuse of medications: polypharmacy and overdosing

Polymedicine describes the use of an increasing number of drugs related

to an increasing number of medical problems, while polypharmacy is

defined as inappropriate use of multiple drugs. While there is no

standard marker for when a patient’s polymedicine list becomes

polypharmacy, “increasing the number of medications increases the risk

of drug-drug interactions and adverse drug events,” says Pham, “and

reviews of medications should be routine.”

The “brown-bag” method, where patients bring all of their medications in

a brown bag to the physician’s office, can lead to dropping at least one

medicine in 20 percent of patients and a change in medication in 29

percent of patients.

Pham and Dickman highlight other methods, from systematic reviews, found

to be effective in reducing inappropriate prescriptions. These include

using a team approach involving pharmacists and nurses to evaluate drug

regimens and suggest changes; exploring nonpharmacologic treatment

options, such as exercise or cognitive therapy; and using advances in

technology, including personal digital assistants and computerized

alerts with health records, to reduce adverse events.

--Avoiding underuse of medication: underprescribing and nonadherence

“Despite concerns about overprescribing, many conditions remain

underdiagnosed or undertreated,” write the authors. “Ascribing all

symptoms to degenerative disease or old age will potentially miss

treatable conditions,” including heart disease, depression, osteoporosis

and pain.

“Nonadherence (or noncompliance) is a complex phenomenon determined by a

variety of issues, including physician-patient communication, cognitive

decline, and the cost of medication,” write the authors. Most

interventions focus on education or on cognitive aids, but the

combination is more promising. In some cases, cost is a factor that will

not be mentioned unless the physician inquires. “Simply asking whether a

patient plans to use his or her prescription may open a dialogue about

the costs of a patient’s prescriptions,” say Dickman, senior author.

“Sometimes there are alternatives, including prescriptions for generic

substitutes or identifying a combination drug that may be less expensive

than two individual drugs.”

“Much drug therapy in older adults is to prevent illnesses by decreasing

risks that will never affect them,” writes Shaughnessy, PharmD,

associate director of the Tufts University Family Medicine Residency, in

an accompanying editorial. Physicians will benefit by finding “the

balance between the potentially lifesaving benefits of medication and

the life-threatening complications of these drugs.”

###

The Tufts University Family Medicine Residency at Tufts University

School of Medicine is based at Cambridge Health Alliance’s Malden Family

Medicine Center.

Pham CB and Dickman RL. American Family Physician. 2007 (December);76

(12):1837- 1844. “Minimizing Adverse Drug Events in Older Patients.”

Shaughnessy AF. American Family Physician. 2007 (December);76

(12):1768.“Prescribing for Older Adults: Finding the Balance.”

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