A Brief Synopsis of AFP's "Reducing the Risk of Adverse Drug Events in Older Adults"

This is a brief synopsis of

Reducing the Risk of Adverse Drug Events in Older Adults

RICHARD W. PRETORIUS, MD, MPH; GORDANA GATARIC, MD; STEVEN K. SWEDLUND, MD; and JOHN R. MILLER, RPh, Wright State University Boonshoft School of Medicine, Dayton, Ohio

Am Fam Physician. 2013 Mar 1;87(5):331-336.

http://www.aafp.org/afp/2013/0301/p331.html

     If you are like me, then you have a lot of friends on Facebook who like to remind you about  how many deaths are caused by medicine. This article focuses on a common problem in medicine, which can and should be prevented. Patients are often on medication that is either redundant, unnecessary  or inappropriate.  Over 16% of older adults hospital admissions is due to an adverse drug event (33% of patients older than 75 years). The 5 categories of adverse drug events are:
1) adverse drug reactions
2) medication error
3) therapeutic failure
4) adverse drug withdrawal event
5) overdose
     The most common medications with adverse events are antithrombotics, diuretics, and NSAIDs. The most common manifestations are falls, orthostatic hypotension, heart failure, and delirium  There are specific medications that should be avoided. Antipsychotics should not be prescribed for more than a month at a time. NSAIDs should be limited to 3 weeks at a time. PPIs should be reevaluated after 8 weeks. Aspirin should only be used if patients have a history of vascular issues or arterial occlusion. Benzodiazepines and SSRIs should be avoided in patients with a fall history.
     It is important that prescribers know the side effects of the medications that they are handing out. The patient should know them as well.  Medications that people have been on long term may need to be age adjusted. Often times, patients are given medications or dosages for short term use, and they never get stopped or reduced. Self medication or OTC medications can add to the problems as well. Starting more than 1 medication at a time can lead to confusion as to which medication is the culprit. Medications should be given at the lowest acceptable dose and then increased as needed.  If side effects do occur, its better to try and lower the dose rather than adding another medication to treat the side effects.
     It is paramount to review medication lists regularly with the patient.  Several clinical tools have been developed (Beers, Stopp, and Start) to avoid these situations. Patient should be questioned about possible ad verve conditions or side affects at every visit. Visits should be frequent and at regular intervals.  Clinical judgement is important as well.