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In-hospital adverse drug reactions in older adults; prevalence, presentation and associated drugs—a systematic review and meta-analysis.
- Source :
- Age & Ageing; Nov2020, Vol. 49 Issue 6, p948-958, 11p, 1 Diagram, 3 Charts, 1 Graph
- Publication Year :
- 2020
-
Abstract
- Background the prevalence of adverse drug reactions (ADRs) in hospitalised older patients, their clinical presentations, causative drugs, severity, preventability and measurable outcomes are unclear, ADRs being an increasing challenge to older patient safety. Methods we systematically searched PubMed, Embase, EBSCO-CINAHL, the Cochrane Library, 'rey' literature and relevant systematic review bibliographies, published from database inception to March 2020. We included any study reporting occurrence of in-hospital ADRs as primary or secondary outcomes in hospitalised older adults (mean age ≥ 65 years). Two authors independently extracted relevant information and appraised studies for bias. Study characteristics, ADR clinical presentations, causative drugs, severity, preventability and clinical outcomes were analysed. Study estimates were pooled using random-effects meta-analytic models. Results from 2,399 abstracts, we undertook full-text screening in 286, identifying 27 studies (29 papers). Final analysis yielded a pooled ADR prevalence of 16% (95%CI 12–22%, I <superscript>2</superscript> 98%, τ <superscript>2</superscript> 0.8585), in a population of 20,153 hospitalised patients aged ≥65 years of whom 2,479 patients experienced ≥ one ADR. ADR ascertainment was highly heterogeneous. Almost 48.3% of all ADRs involved five presentations: fluid/electrolyte disturbances (17.3%), gastrointestinal motility/defaecation disorders (13.3%), renal disorders (8.2%), hypotension/blood pressure dysregulation disorders/shock (5.5%) and delirium (4.1%). Four drug classes accounted for 57.8% of causative medications i.e. diuretics (19.8%), anti-bacterials (14.8%), antithrombotic agents (12.2%) and analgesics (10.9%). Pooled analysis of severity was not feasible. Four studies reported the majority of ADRs as preventable (55–95%). Conclusions on average, 16% of hospitalised older patients experience significant ADRs, varying in severity and mostly preventable, with commonly prescribed drug classes accounting for most ADRs. [ABSTRACT FROM AUTHOR]
- Subjects :
- PREVENTION of drug side effects
FIBRINOLYTIC agents
ANALGESICS
ANTI-infective agents
CINAHL database
CONFIDENCE intervals
DEFECATION
DELIRIUM
DIURETICS
DRUG side effects
DRUG toxicity
GASTROINTESTINAL motility
HOSPITAL patients
HYPOTENSION
INFORMATION storage & retrieval systems
MEDICAL databases
MEDICAL information storage & retrieval systems
KIDNEY diseases
EVALUATION of medical care
MEDLINE
META-analysis
ONLINE information services
SHOCK (Pathology)
WATER-electrolyte imbalances
SYSTEMATIC reviews
COMORBIDITY
POLYPHARMACY
OLD age
Subjects
Details
- Language :
- English
- ISSN :
- 00020729
- Volume :
- 49
- Issue :
- 6
- Database :
- Complementary Index
- Journal :
- Age & Ageing
- Publication Type :
- Academic Journal
- Accession number :
- 146608408
- Full Text :
- https://doi.org/10.1093/ageing/afaa188