Preventable and Non-Preventable Risk Factors for Adverse Drug Events Related to Hospital Admission in the Elderly

J. Doucet, A. Jego, D. Noel, C.E. Geffroy, C. Capet, A. Coquard, E. Couffin, A.L. Fauchais, P. Chassagne, D. Mouton-Schleifer and E. Bercoff

Disclosures

Clin Drug Invest. 2002;22(6)

Conclusion

Our study emphasised the high percentage of preventable risk factors in ADEs related to hospital admissions in the elderly. Our results confirmed the role of DDIs and excess doses of drugs as preventable risk factors. They also demonstrated that chronic interfering diseases must be taken into account before prescribing a new drug. Finally, the increasing use of drug monitoring in elderly patients, continued over a long period to include the occurrence of an interfering acute disease, may hopefully decrease the prevalence of ADEs.

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Reprint Address

Prof. J. Doucet, Service de Medecin Geriatrique, CHU Rouen, 76031 Rouen Cedex, France. E-mail: jean.doucet@chu-rouen.fr

Cite this: Preventable and Non-Preventable Risk Factors for Adverse Drug Events Related to Hospital Admission in the Elderly - Medscape - Jun 01, 2002.

Table I. Signs or symptoms of adverse drug events
Signs or symptoms	n = 500 (%)
Cardiovascular (orthostatic arterial hypotension, heart rhythm or conduction impairment)	141 (28.2)
Metabolic or renal (dehydration, ionic disorders, renal failure)	129 (25.8)
Neuropsychological (vigilance impairment, delirium, agitation)	76 (15.2)
Digestive (diarrhoea, vomiting)	50 (10)
Haemorrhagic (digestive or cerebral bleeding)	44 (8.8)
Cutaneous (rash, pruritus, urticaria)	34 (6.8)
Pulmonary (respiratory failure)	12 (2.4)
Haematological (agranulocytosis, pancytopenia)	5 (1)
Other	9 (1.8)

Table II. Drug classes involved in the 500 adverse drug events
Drug class [no. (%)]	Drugs (n = 1034)
Cardiovascular drugs [452 (43.7%)]	Diuretics (186)
	Angiotensin-converting enzyme inhibitors (80)
	Digoxin preparations (67)
	Calcium antagonists (49)
	Beta-blockers (37)
	Other antiarrhythmics (33)
Psychotropic drugs [322 (31.1%)]	Anxiolytics [hypnotics] (142)^a
	Antidepressants (101)^b
	Antipsychotics (79)^c
Antibiotics [68 (6.6%)]^d
Anticoagulants [44 (4.3%)]	Oral anticoagulants (33)
Anticoagulants [44 (4.3%)]	Heparin (11)
Other drugs [148 (14.3%)]^e

^a Anxiolytics (n = 80) were mainly bromazepam (n = 16), lorazepam (n = 14), oxazepam (n = 11), alprazolam (n = 9), clorazepate (n = 8) and prazepam (n = 6). Hypnotics (n = 62) were mainly zopiclone (n = 15), combination of clorazepate-acepromazin-aceprometazin (n = 15), flunitrazepam (n = 9), nitrazepam (n = 9) and zolpidem (n = 9).
^b Antidepressants were mainly amitriptyline (n = 21), clomipramine (n = 18), fluoxetine (n = 14), mianserin (n = 12), paroxetine (n = 8) and citalopram (n = 8).
^c Neuroleptics were mainly haloperidol (n = 28), chlorpromazine (n = 16), cyamemazin (n = 11) and thioridazine (n = 11).
^d Antibiotics were mainly amoxicillin, in combination with clavulanic acid (n = 29) or alone (n = 9), quinolones (ciprofloxacin, ofloxacin, norfloxacin, n = 19) and sulphamethoxazole-trimethoprim (n = 11).
^e Other drugs included nonsteroidal anti-inflammatory drugs (2.1%), corticosteroids (1.8%)

Table III. Risk factors associated with 406 of the 500 adverse drug events (ADEs)
Risk factors	ADEs	Preventable risk factors	Non-preventable risk factors
Drug-drug interaction	303	141	162
Interfering acute disease	221		221
Excess dose	74	74
Associated chronic disease	55	55

Table IV. Number of risk factors per adverse drug events (ADEs) and ADEs with preventable combination of risk factors
Risk factors per ADEs	ADEs (n = 500)	ADEs with preventable combination of risk factors (n = 201)
3	29 (5.8%)	4
2	187 (37.4%)	41
1	192 (38.4%)	156
0	92 (18.4%)

Table III. Risk factors associated with 406 of the 500 adverse drug events (ADEs)
Risk factors	ADEs	Preventable risk factors	Non-preventable risk factors
Drug-drug interaction	303	141	162
Interfering acute disease	221		221
Excess dose	74	74
Associated chronic disease	55	55

Table IV. Number of risk factors per adverse drug events (ADEs) and ADEs with preventable combination of risk factors
Risk factors per ADEs	ADEs (n = 500)	ADEs with preventable combination of risk factors (n = 201)
3	29 (5.8%)	4
2	187 (37.4%)	41
1	192 (38.4%)	156
0	92 (18.4%)

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Preventable and Non-Preventable Risk Factors for Adverse Drug Events Related to Hospital Admission in the Elderly

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