Epidemiology of medication-related adverse events in nursing homes.

BACKGROUND Nursing home residents are prescribed more medications than patients in any other clinical setting. Although pharmacotherapy for older nursing home residents is usually safe and effective, it can lead to medication-related adverse events such as adverse drug reactions (ADRs), adverse drug withdrawal events (ADWEs), and therapeutic failures (TFs). OBJECTIVE This article reviews the descriptive (incidence) and analytic (risk factor) epidemiology of medication-related adverse events occurring in nursing home residents as reported in the literature during the last 2 decades. METHODS A search of MEDLINE and International Pharmaceutical Abstracts was conducted for articles published in English between January 1986 and July 2006 using the following terms: adverse drug events, adverse drug reactions, adverse drug withdrawal events, aged, drug therapy, drug-related problems, medication-related problems, nursing homes, therapeutic failures, and treatment failures. The reference lists of identified articles, recent review articles, book chapters, and the authors' reference library were also searched manually. RESULTS Seven studies met the inclusion and exclusion criteria and were included in this review. Five studies described ADRs, 1 described ADWEs, and 1 described TFs. The studies of ADRs used different methods of detecting ADRs, resulting in incidence rates ranging from 1.19 to 7.26 per 100 resident-months. The single study of ADWEs reported an incidence of 2.60 per 100 resident-months. An incidence rate for the single study describing TFs could not be calculated. CONCLUSIONS Medication-related adverse events are common in the nursing home setting. Additional studies are needed to enhance the detection and prevention of medication-related adverse events and to reduce their impact on residents' outcomes and health care costs.

[1]  J W Cooper,et al.  Adverse drug reaction-related hospitalizations of nursing facility patients: a 4-year study. , 1999, Southern medical journal.

[2]  R S Evans,et al.  Computerized surveillance of adverse drug events in hospital patients. 1991. , 1991, Quality & safety in health care.

[3]  Albert Figueras,et al.  Adverse Drug Reactions in an Elderly Hospitalised Population , 2005, Drugs & aging.

[4]  G. Alexander,et al.  Reconsidering medication appropriateness for patients late in life. , 2006, Archives of internal medicine.

[5]  Ron Goeree,et al.  Effect of a clinical pathway to reduce hospitalizations in nursing home residents with pneumonia: a randomized controlled trial. , 2006, JAMA.

[6]  M. Afilalo,et al.  Emergency physician recognition of adverse drug-related events in elder patients presenting to an emergency department. , 2005, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[7]  C. Dumont,et al.  MEDICATION APPROPRIATENESS INDEX: RELIABILITY AND RECOMMENDATIONS FOR FUTURE USE , 2006, Journal of the American Geriatrics Society.

[8]  J. Avorn,et al.  Epidemiology of Adverse Drug Events in the Nursing Home Setting , 1995, Drugs & aging.

[9]  D. Classen,et al.  Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality. , 1997, JAMA.

[10]  C. Gatsonis,et al.  Characteristics of the SAGE database: a new resource for research on outcomes in long-term care. SAGE (Systematic Assessment of Geriatric drug use via Epidemiology) Study Group. , 1999, The journals of gerontology. Series A, Biological sciences and medical sciences.

[11]  K. Lapane,et al.  Identifying nursing home residents at high risk for preventable adverse drug events: modifying a tool for use in the Fleetwood Phase III Study. , 2004, The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists.

[12]  S. Thirstrup,et al.  Reliability of a modified medication appropriateness index in primary care , 2005, European Journal of Clinical Pharmacology.

[13]  Naoki Ikegami,et al.  Prevalence of inappropriate medication using Beers criteria in Japanese long-term care facilities , 2006, BMC geriatrics.

[14]  R. Platt,et al.  Computerized Prescribing Alerts and Group Academic Detailing to Reduce the Use of Potentially Inappropriate Medications in Older People , 2006, Journal of the American Geriatrics Society.

[15]  J. Cooper Probable Adverse Drug Reactions in a Rural Geriatric Nursing Home Population: A Four‐Year Study , 1996, Journal of the American Geriatrics Society.

[16]  David W Bates,et al.  Medication errors observed in 36 health care facilities. , 2002, Archives of internal medicine.

[17]  G. Geisslinger,et al.  Computerized surveillance of adverse drug reactions in hospital: Implementation , 1999, European Journal of Clinical Pharmacology.

[18]  S. Willis,et al.  Congruence of Medication Information from a Brown Bag Data Collection and Pharmacy Records: Findings from the Seattle Longitudinal Study , 2005, Experimental aging research.

[19]  D. Bates,et al.  The Costs of Adverse Drug Events in Hospitalized Patients , 1997 .

[20]  S. Studenski,et al.  Medication error reporting in long term care. , 2004, The American journal of geriatric pharmacotherapy.

[21]  C. Hughes,et al.  Information is care: the need for data to assess the quality of care in UK nursing and residential homes , 2003, Expert opinion on drug safety.

[22]  J. Hanlon,et al.  Incidence and predictors of all and preventable adverse drug reactions in frail elderly persons after hospital stay. , 2006, The journals of gerontology. Series A, Biological sciences and medical sciences.

[23]  R. Palmer,et al.  Suboptimal medication use and mortality in an older adult community-based cohort: results from the Hispanic EPESE Study. , 2006, The journals of gerontology. Series A, Biological sciences and medical sciences.

[24]  S. Gavi,et al.  Adverse events due to discontinuations in drug use and dose changes in patients transferred between acute and long-term care facilities. , 2004, Archives of internal medicine.

[25]  D W Bates,et al.  Incidence and preventability of adverse drug events in nursing homes. , 2000, The American journal of medicine.

[26]  J. Delafuente,et al.  Therapeutics in the Elderly , 1995 .

[27]  Jalpa A Doshi,et al.  National Estimates of Medication Use in Nursing Homes: Findings from the 1997 Medicare Current Beneficiary Survey and the 1996 Medical Expenditure Survey , 2005, Journal of the American Geriatrics Society.

[28]  Carl F. Pieper,et al.  Identification of Elderly Nursing Facility Residents at High Risk for Drug-Related Problems , 2005 .

[29]  D. Bates,et al.  Risk factors for adverse drug events among nursing home residents. , 2001, Archives of internal medicine.

[30]  P. Chyka,et al.  How many deaths occur annually from adverse drug reactions in the United States? , 2000, The American journal of medicine.

[31]  Mikel Aickin,et al.  Electronic Medical Record Reminder Improves Osteoporosis Management After a Fracture: A Randomized, Controlled Trial , 2006, Journal of the American Geriatrics Society.

[32]  Jeffrey K Aronson,et al.  Clarification of Terminology in Drug Safety , 2005, Drug safety.

[33]  D. Classen,et al.  Methodology and rationale for the measurement of harm with trigger tools , 2003, Quality & safety in health care.

[34]  F Y Aoki,et al.  Drug‐Associated Hospital Admissions in Older Medical Patients , 1988, Journal of the American Geriatrics Society.

[35]  R. Resar,et al.  Medication Safety: One Organization's Approach to the Challenge , 2001 .

[36]  Linda Gavendo,et al.  The incidence of adverse drug events in two large academic long-term care facilities. , 2005, The American journal of medicine.

[37]  David W Bates,et al.  The Costs Associated With Adverse Drug Events Among Older Adults in the Ambulatory Setting , 2005, Medical care.

[38]  Julia K. Nguyen,et al.  Polypharmacy as a risk factor for adverse drug reactions in geriatric nursing home residents. , 2006, The American journal of geriatric pharmacotherapy.

[39]  P. Corey,et al.  Incidence of Adverse Drug Reactions in Hospitalized Patients , 2012 .

[40]  G. Onder,et al.  Impact of inappropriate drug use among hospitalized older adults , 2005, European Journal of Clinical Pharmacology.

[41]  Laurent Azoulay,et al.  Inappropriate medication prescribing in community-dwelling elderly people living in Iran , 2005, European Journal of Clinical Pharmacology.

[42]  J. Avorn,et al.  Drug Use in the Nursing Home , 1996, Annals of Internal Medicine.

[43]  T. Dantoine,et al.  Predicting and Preventing Adverse Drug Reactions in the Very Old , 2005, Drugs & aging.

[44]  G. Alexander,et al.  Prioritizing and stopping prescription medicines , 2006, Canadian Medical Association Journal.

[45]  R. Beyth,et al.  Epidemiology of Adverse Drug Reactions in the Elderly by Drug Class , 1999, Drugs & aging.

[46]  M. Haan,et al.  Antidepressant class and dosing among older Mexican Americans: application of geropsychiatric treatment guidelines. , 2006, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[47]  Miriam C J M Sturkenboom,et al.  Inappropriate drug prescribing in older adults: the updated 2002 Beers criteria--a population-based cohort study. , 2005, British journal of clinical pharmacology.

[48]  A. Spinewine,et al.  Implementation of Ward-Based Clinical Pharmacy Services in Belgium—Description of the Impact on a Geriatric Unit , 2006, The Annals of pharmacotherapy.

[49]  J L Bootman,et al.  The health care cost of drug-related morbidity and mortality in nursing facilities. , 1997, Archives of internal medicine.

[50]  D. Schreiber,et al.  Drug-Related Emergency Department Visits in an Elderly Veteran Population , 2005, The Annals of pharmacotherapy.

[51]  P. Aspden,et al.  Preventing Medication Errors , 2007 .

[52]  Robert Howard,et al.  Effect of enhanced psychosocial care on antipsychotic use in nursing home residents with severe dementia: cluster randomised trial , 2006, BMJ : British Medical Journal.

[53]  George Hripcsak,et al.  Review Paper: Detecting Adverse Events Using Information Technology , 2003, J. Am. Medical Informatics Assoc..

[54]  J. Hallas,et al.  Drug related events and drug utilization in patients admitted to a geriatric hospital department. , 1991, Danish medical bulletin.

[55]  G Geisslinger,et al.  Retrospective analysis of the frequency and recognition of adverse drug reactions by means of automatically recorded laboratory signals. , 1999, British journal of clinical pharmacology.

[56]  J. Dimant Medication errors and adverse drug events in nursing homes: problems, causes, regulations, and proposed solutions. , 2002, Journal of the American Medical Directors Association.

[57]  P. Fayers,et al.  Patterns of drug prescription in a geriatric evaluation and management unit as compared with the general medical wards: a randomised study , 2005, European Journal of Clinical Pharmacology.

[58]  A. Egberts,et al.  Adverse drug events in hospitalized patients A comparison of doctors, nurses and patients as sources of reports , 1999, European Journal of Clinical Pharmacology.

[59]  P. Routledge,et al.  Adverse drug reactions in elderly patients. , 2003, British journal of clinical pharmacology.

[60]  F. Lu,et al.  Use of the Beers Criteria to Predict Adverse Drug Reactions Among First‐Visit Elderly Outpatients , 2005, Pharmacotherapy.

[61]  J. Cornell,et al.  Adverse Events Related to Drugs and Drug Withdrawal in Nursing Home Residents , 1993, Journal of the American Geriatrics Society.

[62]  G P Samsa,et al.  Adverse events after discontinuing medications in elderly outpatients. , 1997, Archives of internal medicine.

[63]  R. Resar,et al.  Adverse drug event trigger tool: a practical methodology for measuring medication related harm , 2003, Quality & safety in health care.