Abstract
Objective
The trend towards polypharmacy is increasing among the elderly, and associated with this trend is an increased risk of adverse drug effects and drug-drug interactions. Our objective was to assess whether drug adverse effects reported by patients are in general agreement with those identified by a physician.
Methods
We evaluated the medication of 404 randomly selected individuals aged 75 years or older by means of interviews carried out by trained nurses and examinations conducted by a physician. The medication used by these patients was recorded prior to the physician’s examination and modified thereafter if considered appropriate. Adverse effects noted by the physician were compared to those self-reported by the patients.
Results
Almost all of the patients (98.8%) were using at least one drug, and the mean total number of drugs used was 6.5. Adverse effects were self-reported by 11.4% of the patients, whereas the physician observed apparent adverse drug effects in 24.0% of the patients. No adverse effects were reported in 53.2% of the patients. There were only seven patients that had adverse effects that were both self-reported and identified by the physician, and only four of these patients reported the same adverse effect that had been identified by the physician.
Conclusion
There was a great disparity between the adverse effects identified by the physician and those reported by the patients themselves. Based on our results, it would appear that elderly people tend to neglect adverse drug effects and may consider them to be an unavoidable part of normal ageing. Therefore, physicians should enquire about possible adverse effects even though elderly patients may not complain of any drug-related problems.
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References
Linjakumpu T, Hartikainen S, Klaukka T, Veijola J, Kivela SL, Isoaho R (2002) Use of medications and polypharmacy are increasing among the elderly. J Clin Epidemiol 55:809–817
Lernfelt B, Samuelsson O, Skoog I, Landahl S (2003) Changes in drug treatment in the elderly between 1971 and 2000. Eur J Clin Pharmacol 59:637–644
Jyrkkä J, Vartiainen L, Hartikainen S, Sulkava R, Enlund H (2006) Increasing use of medicines in elderly persons: a five-year follow-up of the Kuopio 75+Study. Eur J Clin Pharmacol 62:151–158
Nguyen JK, Fouts MM, Kotabe SE, Lo E (2006) Polypharmacy as a risk factor for adverse drug reactions in geriatric nursing home residents. Am J Geriatr Pharmacother 4:36–41
Delafuente JC (2003) Understanding and preventing drug interactions in elderly patients. Crit Rev Oncol Hematol 48:133–143
Hohl CM, Dankoff J, Colacone A, Afilalo M (2001) Polypharmacy, adverse drug-related events, and potential adverse drug interactions in elderly patients presenting to an emergency department. Ann Emerg Med 38:666–671
Raschetti R, Morgutti M, Menniti-Ippolito F, Belisari A, Rossignoli A, Longhini P, La Guidara C (1999) Suspected adverse drug events requiring emergency department visits or hospital admissions. Eur J Clin Pharmacol 54:959–963
Turnheim K (2004) Drug therapy in the elderly. Exp Gerontol 39:1731–1738
Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH (2003) Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med 163:2716–2724
Barnett MJ, Perry PJ, Langstaff JD, Kaboli PJ (2006) Comparison of rates of potentially inappropriate medication use according to the Zhan criteria for VA versus private sector medicare HMOs. J Manage Care Pharm 12:362–370
Cannon KT, Choi MM, Zuniga MA (2006) Potentially inappropriate medication use in elderly patients receiving home health care: a retrospective data analysis. Am J Geriatr Pharmacother 4:134–143
De Wilde S, Carey IM, Harris T, Richards N, Victor C, Hilton SR, Cook DG (2006) Trends in potentially inappropriate prescribing amongst older UK primary care patients. Pharmacoepidemiol Drug Saf
WHO (2004) ATC Classification index with DDDs 2005. WHO Collaborating Centre for Drug Statistics Methodology, Oslo
WHO (1995) Guidelines for ATC classification and DDD assignment. WHO Collaborating Centre for Drug Statistics Methodology, Oslo
Streim JE, Katz IR (1994) Federal regulations and the care of patients with dementia in the nursing home. Med Clin North Am 78:895–909
Chahine LM, Bijlsma A, Hospers AP, Chemali Z (2006) Dementia and depression among nursing home residents in Lebanon: a pilot study. Int J Geriatr Psychiatry
Raivio MM, Laurila JV, Strandberg TE, Tilvis RS, Pitkala KH (2006) Use of inappropriate medications and their prognostic significance among in-hospital and nursing home patients with and without dementia in Finland. Drugs Aging 23:333–343
Boockvar K, Fishman E, Kyriacou CK, Monias A, Gavi S, Cortes T (2004) Adverse events due to discontinuations in drug use and dose changes in patients transferred between acute and long-term care facilities. Arch Intern Med 164:545–550
Koopmans RT, van der Borgh JP, Bor JH, Hekster YA (2003) Increase in drug use after admission to Dutch nursing homes. Pharm World Sci 25:30–34
Barat I, Andreasen F, Damsgaard EM (2000) The consumption of drugs by 75-year-old individuals living in their own homes. Eur J Clin Pharmacol 56:501–509
Veehof L, Stewart R, Haaijer-Ruskamp F, Jong BM (2000) The development of polypharmacy.A longitudinal study. Fam Pract 17:261–267
Acknowledgements
We thank Ms. Piia Lavikainen for help with the statistics and Dr. Ewen MacDonald for linguistic advice.
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Lampela, P., Hartikainen, S., Sulkava, R. et al. Adverse drug effects in elderly people – a disparity between clinical examination and adverse effects self-reported by the patient. Eur J Clin Pharmacol 63, 509–515 (2007). https://doi.org/10.1007/s00228-007-0283-7
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DOI: https://doi.org/10.1007/s00228-007-0283-7