SEATTLE – Nursing home patients have a higher rate of adverse drug reactions than is sometimes seen in intensive care units, and many of these events occur right after the patient gets out of the hospital, where medication regimens generally get changed, Joseph T. Hanlon, Pharm.D., said at the annual meeting of the American Geriatrics Society.
Studies suggest that up to 50% of persons in a nursing home have some kind of adverse drug event every 6 months, and while many of those are relatively minor events, they can be serious. Older persons have a fourfold higher risk of hospitalization from an adverse drug reaction than younger people, said Dr. Hanlon, a professor of pharmacology and geriatric medicine at the University of Pittsburgh.
“Medication-related adverse patient events are really common and a major source of morbidity in older people,” he said.
Adverse drug reactions can and do occur at any time. But one study found that 20% of elderly persons had an adverse drug reaction in the first month after hospitalization, with most of those events caused by a prescription that was new to the patient.
Moreover, in his own study of 808 elderly patients discharged from 1 of 11 Veterans Affairs hospitals, Dr. Hanlon found that one-third of the patients had an adverse drug event, and most of those events occurred within 3 months of the hospitalization. Forty percent of the events were preventable, his study concluded.
“The point is, going to the hospital is a bad thing,” Dr. Hanlon said. However, the research is not very clear on what can be done to reduce adverse drug events in the elderly, Dr. Hanlon said. Most trials have looked at using a geriatrics team or a pharmacist to review medications. One randomized, controlled study found that pharmacist review cut adverse drug events 32%. But most of the other studies have found that while that type of approach may improve the quality of prescribing, it has not shown a reduction in adverse events.
Clearly, the complexity of the drug regimens that elderly people are put on is partly to blame, and in the U.K., pharmacists review a patients' medications every year in order to prune unnecessary or redundant medications, Dr. Hanlon said.
In Australia, the medical schools have started teaching medical students simple pharmacotherapy about of the most commonly used drugs and five basic things they need to know about each one.
“I haven't heard much about us embracing that in the [United States], and I think that is an area that we need to move forward on,” he said
Dr. Hanlon said when he talks to physicians, he recommends they take the simple step of having patients bring in a list of their medications for review, matching each of the drugs to their conditions, and getting rid of what is not needed.
That step can actually solve two-thirds of the medication problems, he said.