Abstract
Medications are commonly used by older adults. While medications can relieve symptoms and prevent further disease complications, they unfortunately can also cause adverse drug events (ADEs). An ADE can be defined as “an injury resulting from the use of a drug” (Aspden et al. 2007; Nebeker et al. 2004). The right side of Fig. 1 shows the three types of ADEs: (1) adverse drug reactions (ADRs) (i.e., a response to a drug that is noxious and unintended and occurs at doses normally used for the prophylaxis, diagnosis, or therapy of disease or for modification of physiological function); (2) therapeutic failures (TFs) (i.e., failure to accomplish the goals of treatment resulting from inadequate drug therapy and not related to the natural progression of disease); and (3) adverse drug withdrawal reactions (ADWEs) (i.e., a clinical set of symptoms or signs that are related to the removal of a drug) (Edwards and Aronson 2000; Hanlon et al. 2010). Besides death, which fortunately is rarely due to medications, one of the worst consequences of medication use in older adults is hospitalization. Studies have shown that up to 16 % of hospital admissions are due to ADRs, up to 11 % due to TFs, and approximately 1 % due to ADWEs (Beijer and de Blaey 2002; Kaiser et al. 2006; Marcum et al. 2011). Taken together, these medication-related problems are a significant cause of morbidity and mortality as well as unnecessary healthcare costs in older adults.
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References
Aspden P, Wolcott J, Bootman L, Cronenwett LR, for the IOM Committee on Identifying and Preventing Medication Errors (eds) (2007) Preventing medication errors: quality chasm series. National Academies Press, Washington, DC
Barker KN, Flynn EA, Pepper GA (2002a) Observation method of detecting medication errors. Am J Health Syst Pharm 59:2314–2316
Barker KN, Flynn EA, Pepper GA et al (2002b) Medication errors observed in 36 health care facilities. Arch Intern Med 162:1897–1903
Beijer HJ, de Blaey CJ (2002) Hospitalisations caused by adverse drug reactions (ADR): a meta-analysis of observational studies. Pharm World Sci 24:46–54
Bhardwaja B, Carroll NM, Raebel MA et al (2011) Improving prescribing safety in patients with renal insufficiency in the ambulatory setting: the Drug Renal Alert Pharmacy (DRAP) program. Pharmacotherapy 31:346–356
Campbell N, Boustani M, Limbil T et al (2009) The cognitive impact of anticholinergics: a clinical review. Clin Interv Aging 4:225–233
Centers for Disease Control and Prevention (2007) Prevalence of chronic kidney disease and associated risk factors—United States, 1999–2004. MMWR Morb Mortal Wkly Rep 56:161–165
Centers for Medicare and Medicaid Services (2006) State operations manual: surveyor guidance for unnecessary medications (F329). http://www.cms.hhs.gov/transmittals/downloads/R22SOMA.pdf. Accessed 2 Oct 2011
Chertow GM, Lee J, Kuperman GJ et al (2001) Guided medication dosing for inpatients with renal insufficiency. JAMA 286:2839–2844
Dimitrow MS, Airaksinen MS, Kivelä SL et al (2011) Comparison of prescribing criteria to evaluate the appropriateness of drug treatment in individuals aged 65 and older: a systematic review. J Am Geriatr Soc 59:1521–1530
Edwards IR, Aronson JK (2000) Adverse drug reactions: definitions, diagnosis, and management. Lancet 356:1255–1259
Field TS, Rochon P, Lee M et al (2009) Computerized clinical decision support during medication ordering for long-term care residents with renal insufficiency. J Am Med Inform Assoc 16:480–485
Flynn EA, Barker KN, Berger BA et al (2009) Dispensing errors and counseling quality in 100 pharmacies. J Am Pharm Assoc 49:171–180
Gallagher P, Ryan C, Byrne S et al (2008) STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert Doctors to Right Treatment). Consensus validation. Int J Clin Pharmacol Ther 46:72–83
Gallagher PF, O’Connor MN, O’Mahony D (2011) Prevention of potentially inappropriate prescribing for elderly patients: a randomized controlled trial using STOPP/START criteria. Clin Pharmacol Ther 89:845–854
Hanlon JT, Aspinall S, Semla T et al (2009) Consensus guidelines for oral dosing of primarily renally cleared medications in older adults. J Am Geriatr Soc 57:335–340
Hanlon JT, Handler S, Maher R et al (2010) Geriatric pharmacotherapy and polypharmacy. In: Fillit H, Rockwood K, Woodhouse K (eds) Brocklehurst’s textbook of geriatric medicine, 7th edn. Churchill Livingstone, London, pp 880–885
Hanlon JT, Wang X, Handler SM et al (2011) Potentially inappropriate prescribing of primarily renally cleared medications for older Veterans affairs nursing home patients. J Am Med Dir Assoc 12:377–383
Hines LE, Murphy JE (2011) A review of potentially harmful drug-drug interactions in the elderly: a review. Am J Geriatr Pharmacother 9:364–377
Jeffrey S, Ruby CM, Twersky J, Hanlon JT (1999) Effect of an interdisciplinary team on suboptimal prescribing in a long term care facility. Consult Pharm 14:1386–1391
Kaiser RM, Schmader KE, Pieper CF et al (2006) Therapeutic failure-related hospitalisations in the frail elderly. Drugs Aging 23:579–586
Lang PO, Hasso Y, Dramé M et al (2010) Potentially inappropriate prescribing including under-use amongst older patients with cognitive or psychiatric co-morbidities. Age Ageing 39:373–381
Lisby M, Nielsen LP, Brock B, Mainz J (2010) How are medication errors defined? A systematic literature review of definitions and characteristics. Int J Qual Health Care 22:507–518
Mallet L, Spinewine A, Huang A (2007) The challenge of managing drug interactions in elderly people. Lancet 370:185–191
Marcum ZA, Amuan ME, Hanlon JT et al (2011) Therapeutic failures and adverse drug withdrawal events leading to hospitalization among older outpatient veterans. In: Proceedings of international society for pharmacoepidemiology international conference on pharmacoepidemiology and therapeutic risk management, Chicago
National Coordinating Council for Medication Error Reporting and Prevention (1998) What is a medication error? Rockville. http://www.nccmerp.org. Accessed 30 Dec 2011
Nebeker JR, Barach P, Samore MH (2004) Clarifying adverse drug events: a clinician’s guide to terminology, documentation, and reporting. Ann Intern Med 140:795–801
Papaioannou A, Clarke JA, Campbell G, Bédard M (2000) Assessment of adherence to renal dosing guidelines in long-term care facilities. J Am Geriatr Soc 48:1470–1473
Rahimi AR, Kennedy K, Thomason M et al (2008) Improper renal dosing in long-term care facilities. South Med J 101:802–805
Ryan C, O’Mahony D, Kennedy J et al (2009) Potentially inappropriate prescribing in an Irish elderly population in primary care. Br J Clin Pharmacol 68:936–947
Schmader KE, Hanlon JT, Pieper CF et al (2004) Effects of geriatric evaluation and management on adverse drug reactions and suboptimal prescribing in the frail elderly. Am J Med 116:394–401
Shrank WH, Polinski JM, Avorn J (2007) Quality indicators for medication use in vulnerable elders. J Am Geriatr Soc 55:S373–S382
Spinewine A, Schmader KE, Barber N et al (2007a) Appropriate prescribing in elderly people: how can it be measured and optimised? Lancet 370:173–184
Spinewine A, Swine C, Dhillon S et al (2007b) Effect of a collaborative approach on the quality of prescribing for geriatric inpatients: a randomized, controlled trial. J Am Geriatr Soc 55:658–665
Steinman MA, Handler SM, Gurwitz JH et al (2011) Beyond the prescription: medication monitoring and adverse drug events in older adults. J Am Geriatr Soc 59:1513–1520
Stevens LA, Levey AS (2005) Chronic kidney disease in the elderly—how to assess risk. N Engl J Med 352:2122–2124
Taipale HT, Hartikainen S, Bell JS (2010) A comparison of four methods to quantify the cumulative effect of taking multiple drugs with sedative properties. Am J Geriatr Pharmacother 8:460–471
Vidal L, Shavit M, Fraser A et al (2005) Systematic comparison of four sources of drug information regarding adjustment of dose for renal function. BMJ 331:263
Wright RM, Sloane R, Pieper CM et al (2009) Underuse of indicated medications among physically frail older U.S. Veterans at time of hospital discharge: results of a cross-sectional analysis of data from the Geriatric Evaluation and Management Drug Study. Am J Geriatr Pharmacother 7:271–280
Zimmerman S, Love K, Sloane PD et al (2011) Medication administration errors in assisted living: scope, characteristics, and the importance of staff training. J Am Geriatr Soc 59:1060–1068
Zint K, Haefeli WE, Glynn RJ et al (2010) Impact of drug interactions, dosage, and duration of therapy on the risk of hip fracture associated with benzodiazepine use in older adults. Pharmacoepidemiol Drug Saf 19:1248–1255
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Marcum, Z.A., Hanlon, J.T. (2013). Inappropriate Medication Use and Medication Errors in the Elderly. In: Wehling, M. (eds) Drug Therapy for the Elderly. Springer, Vienna. https://doi.org/10.1007/978-3-7091-0912-0_5
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DOI: https://doi.org/10.1007/978-3-7091-0912-0_5
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