Adverse drug reactions and prescribing in older people
Dear Sir
Prescribing in older people is complicated given the presence of
multiple co-morbidities and age related changes in pharmacokinetics as
described in their article by Milton et al.[1] The risk of an adverse drug
reaction(ADR) increases with age and is proportional to the number of
drugs prescribed and is often a cause for an acute medical admission.[2]
In our audit on 32 consecutive admissions over a week to our ward in the
department of medicine for older people, we found 22 patients(68%) had one
or more ADRs at the time of their admission. Patients who had an ADR were
older(mean age of 86 versus 83yrs) and were prescribed more drugs(5.13
versus 2.3 items). The most common prescriptions in patients with ADR
were for cardiovascular illness(46%, 52/113) followed by paracetamol and
opiate analgesics(12%), ulcer healing drugs(8%), bisphosphanates and
calcium supplements(8%). Prescriptions for sedatives and tricyclic
antidepressants(4%) and non steroidal anti-inflammatory agents(3%) were
observed in only a minority of patients. The most frequent ADR that was
definite was hypotension(41%) followed by electrolyte imbalance(32%). A
number of patients(36%)had new onset anaemia with normal reticulocyte
count and normal investigations into inflammatory, bleeding, nutritional,
renal and liver disorders indicating a probable ADR. It is clear that ADRs
in our older patients were commonly due to a prescription for
cardiovascular illness and were often precipitated by an acute illness
such as an infection. It is often necessary to temporarily discontinue
these prescriptions while waiting for recovery from the acute medical
illness. In some patients we had to discontinue the prescriptions but we
were able to do this in a controlled hospital environment. It is difficult
to see how a pharmacist or doctor can do this in the community without the
provision of close supervision.
References:
1. Milton JC, Hill-Smith I and Jackson SHD. Prescribing for Older People.
BMJ, 2008: 336; 606-609.
2. Pirmohammed M, James S, Meakin S et al. Adverse drug reactions as cause
of admission to hospital: prospective analysis. BMJ, 2004: 329; 15- 19.
Competing interests:
None declared
Competing interests:
No competing interests
21 March 2008
Simran Gandhi
Senior House Officer
Sunku H Guptha, Consultant Physician
Edith Cavell Hospital, Peterborough and Stamford NHSTrust, Peterborough, PE3 9GZ
Rapid Response:
Adverse drug reactions and prescribing in older people
Dear Sir
Prescribing in older people is complicated given the presence of multiple co-morbidities and age related changes in pharmacokinetics as described in their article by Milton et al.[1] The risk of an adverse drug reaction(ADR) increases with age and is proportional to the number of drugs prescribed and is often a cause for an acute medical admission.[2] In our audit on 32 consecutive admissions over a week to our ward in the department of medicine for older people, we found 22 patients(68%) had one or more ADRs at the time of their admission. Patients who had an ADR were older(mean age of 86 versus 83yrs) and were prescribed more drugs(5.13 versus 2.3 items). The most common prescriptions in patients with ADR were for cardiovascular illness(46%, 52/113) followed by paracetamol and opiate analgesics(12%), ulcer healing drugs(8%), bisphosphanates and calcium supplements(8%). Prescriptions for sedatives and tricyclic antidepressants(4%) and non steroidal anti-inflammatory agents(3%) were observed in only a minority of patients. The most frequent ADR that was definite was hypotension(41%) followed by electrolyte imbalance(32%). A number of patients(36%)had new onset anaemia with normal reticulocyte count and normal investigations into inflammatory, bleeding, nutritional, renal and liver disorders indicating a probable ADR. It is clear that ADRs in our older patients were commonly due to a prescription for cardiovascular illness and were often precipitated by an acute illness such as an infection. It is often necessary to temporarily discontinue these prescriptions while waiting for recovery from the acute medical illness. In some patients we had to discontinue the prescriptions but we were able to do this in a controlled hospital environment. It is difficult to see how a pharmacist or doctor can do this in the community without the provision of close supervision.
References: 1. Milton JC, Hill-Smith I and Jackson SHD. Prescribing for Older People. BMJ, 2008: 336; 606-609. 2. Pirmohammed M, James S, Meakin S et al. Adverse drug reactions as cause of admission to hospital: prospective analysis. BMJ, 2004: 329; 15- 19.
Competing interests: None declared
Competing interests: No competing interests