 |
|
Risk Factors for Adverse Drug Events Among Nursing Home Residents
Terry S. Field, DSc;
Jerry H. Gurwitz, MD;
Jerry Avorn, MD;
Danny McCormick, MD, MPH;
Shailavi Jain, RPh;
Marie Eckler, RN, MS, CS, CRRN, GNP;
Marcia Benser, RN, MS;
David W. Bates, MD
Arch Intern Med. 2001;161:1629-1634.
Background In a prospective study of nursing home residents, we found adverse drug
events (ADEs) to be common, serious, and often preventable. To direct prevention
efforts at high-risk residents, information is needed on resident-level risk
factors.
Methods Case-control study nested within a prospective study of ADEs among residents
in 18 nursing homes. For each ADE, we randomly selected a control from the
same home. Data were abstracted from medical records on functional status,
medical conditions, and medication use.
Results Adverse drug events were identified in 410 nursing home residents. Independent
risk factors included being a new resident (odds ratio [OR], 2.8; 95% confidence
interval [CI], 1.5-5.2) and taking anti-infective medications (OR, 4.0; CI,
2.5-6.2), antipsychotics (OR, 3.2; CI, 2.1-4.9), or antidepressants (OR, 1.5;
CI, 1.1-2.3). The number of regularly scheduled medications was associated
with increased risk of ADEs; the OR associated with taking 5 to 6 medications
was 2.0 (CI, 1.2-3.2); 7 to 8 medications, 2.8 (CI, 1.7-4.7); and 9 or more,
3.3 (CI, 1.9-5.6). Taking supplements or nutrients was associated with lower
risk (OR, 0.42; CI, 0.27-0.63). Preventable ADEs occurred in 226 residents.
Independent risk factors included taking opioid medications (OR, 6.6; CI,
2.3-19.3), antipsychotics (OR, 4.0; CI, 2.2-7.3), anti-infectives (OR, 3.0;
CI, 1.6-5.8), antiepileptics (OR, 2.2; CI, 1.1-4.5), or antidepressants (OR,
2.0; CI, 1.1-3.5). Scores of 5 or higher on the Charlson Comorbidity Index
were associated with increased risk of ADEs (OR, 2.6; CI, 1.1-6.0). The number
of regularly scheduled medications was also a risk factor: the OR for 7 to
8 medications was 3.2 (CI, 1.4-6.9) and for 9 or more, 2.9 (CI, 1.3-6.8).
Residents taking nutrients or supplements were at lower risk (OR, 0.27; CI,
0.14-0.50).
Conclusions It is possible to identify nursing home residents at high risk of having
an ADE. Particular attention should be directed at new residents, those with
multiple medical conditions, those taking multiple medications, and those
taking psychoactive medications, opioids, or anti-infective drugs.
From the Meyers Primary Care Institute (Drs Field and Gurwitz and Mss
Jain, Eckler, and Benser) and Department of Medicine, University of Massachusetts
Medical School (Drs Field and Gurwitz), Worcester; Divisions of Pharmacoepidemiology
and Pharmacoeconomics (Dr Avorn) and Medicine (Dr Bates), Brigham and Women's
Hospital, and Department of Medicine, Harvard Medical School (Dr Avorn), Boston,
Mass; and Department of Medicine, Division of Social and Community Medicine,
Cambridge Hospital, Cambridge, Mass (Dr McCormick).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
RELATED ARTICLE
Archives of Internal Medicine Reader's Choice: Continuing Medical Education
Arch Intern Med. 2001;161(13):1683-1684.
FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Comorbidity and repeat admission to hospital for adverse drug reactions in older adults: retrospective cohort study
Zhang et al.
BMJ 2009;338:a2752-a2752.
ABSTRACT
| FULL TEXT
Predictors of Medication Errors Among Elderly Hospitalized Patients
Picone et al.
American Journal of Medical Quality 2008;23:115-127.
ABSTRACT
Indications for Dual Antiplatelet Therapy with Aspirin and Clopidogrel: Evidence-Based Recommendations for Use
Reaume et al.
The Annals of Pharmacotherapy 2008;42:550-557.
ABSTRACT
| FULL TEXT
Patterns of Antimicrobial Use Among Nursing Home Residents With Advanced Dementia
D'Agata and Mitchell
Arch Intern Med 2008;168:357-362.
ABSTRACT
| FULL TEXT
A Drug Burden Index to Define the Functional Burden of Medications in Older People
Hilmer et al.
Arch Intern Med 2007;167:781-787.
ABSTRACT
| FULL TEXT
Medication-related Clinical Decision Support in Computerized Provider Order Entry Systems: A Review
Kuperman et al.
J. Am. Med. Inform. Assoc. 2007;14:29-40.
ABSTRACT
| FULL TEXT
Clinical medication review by a pharmacist of elderly people living in care homes--randomised controlled trial
Zermansky et al.
Age Ageing 2006;35:586-591.
ABSTRACT
| FULL TEXT
Long-term effects of analgesics in a population of elderly nursing home residents with persistent nonmalignant pain.
Won et al.
Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2006;61:165-169.
ABSTRACT
| FULL TEXT
Clinical application of a computerized system for physician order entry with clinical decision support to prevent adverse drug events in long-term care
Rochon et al.
CMAJ 2006;174:52-54.
FULL TEXT
Risk of adverse drug events by patient destination after hospital discharge
Triller et al.
Am J Health Syst Pharm 2005;62:1883-1889.
ABSTRACT
| FULL TEXT
Risk Factors for Adverse Drug Events: A 10-Year Analysis
Evans et al.
The Annals of Pharmacotherapy 2005;39:1161-1168.
ABSTRACT
| FULL TEXT
Polypharmacy: A New Paradigm for Quality Drug Therapy in the Elderly?
Gurwitz
Arch Intern Med 2004;164:1957-1959.
FULL TEXT
Medication Undertreatment in Assisted Living Settings
Sloane et al.
Arch Intern Med 2004;164:2031-2037.
ABSTRACT
| FULL TEXT
Development and Validation of the Medication Regimen Complexity Index
George et al.
The Annals of Pharmacotherapy 2004;38:1369-1376.
ABSTRACT
| FULL TEXT
Using Information Technology To Improve the Health Care of Older Adults
Weiner et al.
ANN INTERN MED 2003;139:430-436.
ABSTRACT
| FULL TEXT
Multidisciplinary medication review in nursing home residents: what are the most significant drug-related problems? The Bergen District Nursing Home (BEDNURS) study
Ruths et al.
Qual Saf Health Care 2003;12:176-180.
ABSTRACT
| FULL TEXT
"At least Mom will be safe there": the role of resident safety in nursing home quality
Kapp
Qual Saf Health Care 2003;12:201-204.
ABSTRACT
| FULL TEXT
Depression and Adverse Drug Reactions Among Hospitalized Older Adults
Onder et al.
Arch Intern Med 2003;163:301-305.
ABSTRACT
| FULL TEXT
Preventing Falls in Elderly Persons
Tinetti
NEJM 2003;348:42-49.
FULL TEXT
Editorial: Hot Topics in Geriatrics
Morley
Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2003;58:M30-36.
FULL TEXT
Health Care-Associated Bloodstream Infections: A Change in Thinking
Gaynes
ANN INTERN MED 2002;137:850-851.
FULL TEXT
Mental Health Services in Nursing Homes: Psychopharmacologic Interventions in Nursing Homes: What Do We Know and Where Should We Go?
Ryan et al.
Psychiatr. Serv. 2002;53:1407-1413.
ABSTRACT
| FULL TEXT
Polypharmacy in Elderly Patients With Diabetes
Good
Diabetes Spectr. 2002;15:240-248.
ABSTRACT
| FULL TEXT
Underestimation of Adverse Drug Events in Nursing Home Residents
Lesser et al.
Arch Intern Med 2002;162:609-610.
FULL TEXT
|
