Skip to main content

Advertisement

SpringerLink
Log in

Adverse drug reactions leading to urgent hospital admission in an elderly population: prevalence and main features

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

To assess the prevalence of urgent hospitalization due to adverse drug reactions (ADRs) in patients aged ≥65 years, to compare the in-hospital mortality rates between patients admitted for ADRs and those admitted for other causes, and to describe the ADRs, the used and suspected drugs, and the drug-reaction associations.

Methods

A cross-sectional study was conducted by using the institutional database of the Pharmacovigilance Programme of Bellvitge University Hospital, a 750-bed tertiary care hospital, with information corresponding to a 7-year period. ADR-related admissions of patients aged ≥65 years prospectively identified through a systematic daily review of all admission diagnosis were reviewed.

Results

ADRs were suspected to be the main reason for urgent admission in 1976 out of 60,263 patients aged ≥65 years (prevalence of ADR-related hospitalization 3.3 % [95 % CI 3.1–3.4 %]). The crude in-hospital mortality rate was 10.2 % in patients with ADR-related admission and 9 % in patients admitted for other causes (p = 0.077). Most patients (86 %) were exposed to polypharmacy, and a drug-drug interaction was suspected in 49 % of cases. The most frequent drug-reaction associations were acute renal failure related to renin-angiotensin system inhibitors, gastrointestinal bleeding caused by antithrombotics and/or non-steroidal anti-inflammatories, and intracranial bleeding induced by vitamin K antagonists.

Conclusions

One out of every 30 urgent admissions of patients aged ≥65 years is ADR-related. These ADRs can be as serious and life-threatening as any other acute pathology that merits urgent hospital admission. Most cases involve patients exposed to polypharmacy and result from well-known reactions of a few commonly used drugs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lehnert T, Heider D, Leicht H, Heinrich S, Corrieri S, Luppa M, Riedel-Heller S, König H-H (2011) Review: health care utilization and costs of elderly persons with multiple chronic conditions. Med Care Res Rev 68:387–420

    Article  PubMed  Google Scholar 

  2. Shi S, Mörike K, Klotz U (2008) The clinical implications of ageing for rational drug therapy. Eur J Clin Pharmacol 64:183–199

    Article  PubMed  Google Scholar 

  3. Routledge PA, O’Mahony MS, Woodhouse KW (2003) Adverse drug reactions in elderly patients. Br J Clin Pharmacol 57:121–126

    Article  Google Scholar 

  4. Beijer HJM, de Blaey CJ (2002) Hospitalisations caused by adverse drug reactions (ADR): a meta-analysis of observational studies. Pharm World Sci 24:46–54

    Article  PubMed  CAS  Google Scholar 

  5. Kongkaew C, Noyce PR, Ashcroft DM (2008) Hospital admissions associated with adverse drug reactions: a systematic review of prospective observational studies. Ann Pharmacother 42:1017–1025

    Article  PubMed  Google Scholar 

  6. Alhawassi TM, Krass I, Bajorek BV, Pont LG (2014) A systematic review of the prevalence and risk factors for adverse drug reactions in the elderly in the acute care setting. Clin Interv Aging 9:2079–2086

    PubMed  PubMed Central  Google Scholar 

  7. Wu C, Bell CM, Wodchis WP (2012) Incidence and economic burden of adverse drug reactions among elderly patients in Ontario Emergency Department. Drug Saf 35:769–781

    Article  PubMed  PubMed Central  Google Scholar 

  8. Pedrós C, Quintana B, Rebolledo M, Porta N, Vallano A, Arnau JM (2014) Prevalence, risk factors and main features of adverse drug reactions leading to hospital admission. Eur J Clin Pharmacol 70:361–367

    Article  PubMed  Google Scholar 

  9. European Comission (2010) Commission Directive 2010/84/EU of the European Parliament and the Council of 15 December 2010 amending as regards pharmacovigilance, Directive 2001/83/EC on the Community code relating to medicinal products for human use. Off J Eur Union 31.12.2010: L348/74-L348/99. http://ec.europa.eu/health/files/eudralex/vol-1/dir_2010_84/dir_2010_84_en.pdf. Accessed 13 Aug 2015

  10. Meyboom RHB, Royer RJ (1992) Causality classification at pharmacovigilance centres in the European community. Pharmacoepidemiol Drug Saf 1:87–97

    Article  Google Scholar 

  11. Onder G, Pedone C, Landi F, Cesari M, Della Vedova C, Bernabei R, Gambassi G (2002) Adverse drug reactions as cause of hospital admissions: results from the Italian Group of Pharmacoepidemiology in the Elderly (GIFA). J Am Geriatr Soc 50:1962–1968

    Article  PubMed  Google Scholar 

  12. Mannesse CK, Derkx FHM, de Ridder MAJ, Man in ‘t Veld AJ, van der Cammen TJM (2000) Contribution of adverse drug reactions to hospital admission of older patients. Age Ageing 29:35–39

    Article  PubMed  CAS  Google Scholar 

  13. Alcalde Tirado P, Dapena Díaz MD, Nieto de Haro MD, Fontecha Gómez BJ (2001) Ingreso hospitalario atribuible a efectos adversos medicamentosos. Rev Esp Geriatr Gerontol 36:340–344

    Article  Google Scholar 

  14. Chan M, Nicklason F, Vial JH (2001) Adverse drug events as a cause of hospital admission in the elderly. Intern Med J 31:199–205

    Article  PubMed  CAS  Google Scholar 

  15. Laroche M-L, Charmes J-P, Nouaille Y, Picard N, Merle L (2007) Is inappropriate medication use a major cause of adverse drug reactions in the elderly? Br J Clin Pharmacol 63:177–186

    Article  PubMed  PubMed Central  Google Scholar 

  16. Franceschi M, Scarcelli C, Niro V, Seripa D, Pazienza AM, Pepe G, Colusso AM, Pacilli L, Pilotto A (2008) Prevalence, clinical features and avoidability of adverse drug reactions as cause of admission to a geriatric unit. A prospective study of 1756 patients. Drug Saf 31:545–556

    Article  PubMed  Google Scholar 

  17. Olivier P, Bertrand L, Tubery M, Lauque D, Montastruc J-L, Lapeyre-Mestre M (2009) Hospitalizations because of adverse drug reactions in elderly patients admitted though the emergency department. A prospective study. Drugs Aging 26:475–482

    Article  PubMed  Google Scholar 

  18. Björkman IK, Fastbom J, Schmidt IK, Bernsten CB, The Pharmaceutical Care of Elderly in Europe Research (PEER) Group (2002) Drug-drug interactions in the elderly. Ann Pharmacother 36:1675–1681

    Article  PubMed  Google Scholar 

  19. Calderón-Larrañaga A, Gimeno-Feliu LA, González-Rubio F, Poblador-Plou B, Lairla-San José M, Abad-Díez JM, Poncel-Falcó A, Prados-Torres A (2013) Polypharmacy patterns: unravelling systematic associations between prescribed medications. PLoS One 8, e84967

    Article  PubMed  PubMed Central  Google Scholar 

  20. Franchi C, Tettamanti M, Pasina L, Djignefa CD, Fortino I, Bortolotti A, Merlino L, Nobili A (2014) Changes in drug prescribing to Italian community-dwelling elderly people: the EPIFARM-Elderly Project 2000–2010. Eur J Clin Parmacol 70:437–443

    Article  CAS  Google Scholar 

  21. Caamaño F, Pedone C, Zuccalà G, Carbonin P (2005) Socio-demographic factors related to the prevalence of adverse drug reaction at hospital admission in elderly population. Arch Gerontol Geriatr 40:45–52

    Article  PubMed  Google Scholar 

  22. Marcum ZA, Amuan ME, Hanlon JT, Aspinall SL, Handler SM, Ruby CM, Pugh MJV (2012) Prevalence of unplanned hospitalizations caused by adverse drug reactions among older veterans. J Am Geriatr Soc 60:34–41

    Article  PubMed  PubMed Central  Google Scholar 

  23. Alexopoulou A, Dourakis SP, Mantzoukis D, Pitsariotis T, Kandyli A, Deutsch M, Archimandritis AJ (2008) Adverse drug reactions as a cause of hospital admission: a 6-month experience in a single center in Greece. Eur J Intern Med 19:505–510

    Article  PubMed  Google Scholar 

  24. Leendertse AJ, Egberts ACG, Stoker LJ, van den Bemt PMLA, The HARM study group (2008) Frequency of and risk factors for presentable medication-related hospital admissions in the Netherlands. Arch Intern Med 168:1890–1896

    PubMed  Google Scholar 

  25. Payne RA, Abel GA, Avery AJ, Mercer SW, Roland MO (2014) Is polypharmacy always hazardous? A retrospective cohort analysis using linked electronic health records from primary and secondary care. Br J Clin Pharmacol 77:1073–1082

    Article  PubMed  PubMed Central  Google Scholar 

  26. Johnell K, Klarin I (2007) The relationship between number of drugs and potential drug-drug interactions in the elderly. A study of over 600,000 elderly patients from the Swedish Prescribed Drug Register. Drugs Saf 30:911–918

    Article  Google Scholar 

  27. Tragni E, Casula M, Pieri V, Favato G, Marcobelli A, Trotta MG, Catapano AL (2013) Prevalence of the prescription of potentially interacting drugs. PLoS One 8, e78827

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  28. Burguess CL, Holman CD'AJ, Satti AG (2005) Adverse drug reactions in older Australians, 1981–2002. Med J Aust 182:267–270

    Google Scholar 

  29. Hartholt KA, van der Velde N, Looman CWN, Panneman MJM, van Beeck EF, Patka P, van der Cammen TJM (2010) Adverse drug reactions related hospital admissions in persons aged 60 years and over, the Netherlands, 1981–2007: less rapid increase, different drugs. PLoS One 5, e13977

    Article  PubMed  PubMed Central  Google Scholar 

  30. Budnitz DS, Loovegrove MC, Shehab N, Richards CL (2011) Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med 365:2002–2012

    Article  PubMed  CAS  Google Scholar 

  31. Conforti A, Constantini D, Zanetti F, Moretti U, Grezzana M, Leone R (2012) Adverse drug reactions in older patients: an Italian observational prospective hospital study. Drug Healthc Patient Saf 4:75–80

    Article  PubMed  PubMed Central  Google Scholar 

  32. Fernández-Liz E, Modamio P, Catalán A, Lastra CF, Rodríguez T, Mariño EL (2007) Identifying how age and gender influence drug use in a primary health care environment in Catalonia, Spain. Br J Clin Pharmacol 65:407–417

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

The authors thank Mr. Angus Powles for his support in linguistic revision of the manuscript.

Contributions of authors statement

Dr Pedrós is the principal investigator of the present study and affirms that everyone who contributed significantly to the present work has been listed as co-author.

Dr Pedrós had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: All authors.

Acquisition of data: Dr Pedrós, Dr Corbella.

Statistical analysis: Dr Pedrós.

Analysis and interpretation of data: All authors.

Administrative, technical, or material support: Dr Pedrós.

Drafting of the manuscript: Dr Pedrós.

Critical revision of the manuscript for important intellectual content: All authors.

Author information

Authors and Affiliations

  1. Clinical Pharmacology Department, Bellvitge University Hospital, c/ Feixa Llarga s/n, 08907, L’Hospitalet de Llobregat, Barcelona, Spain

    Consuelo Pedrós & Josep Maria Arnau

  2. Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain

    Consuelo Pedrós, Francesc Formiga, Xavier Corbella & Josep Maria Arnau

  3. Internal Medicine Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain

    Francesc Formiga & Xavier Corbella

  4. Albert J. Jovell Institute of Public Health and Patients, Faculty of Medicine and Health Sciences, International University of Catalonia, Barcelona, Spain

    Xavier Corbella

  5. Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain

    Josep Maria Arnau

Authors
  1. Consuelo Pedrós
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francesc Formiga
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xavier Corbella
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Josep Maria Arnau
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Consuelo Pedrós.

Ethics declarations

Funding

No sources of funding were used to assist in the development of this study.

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving animals were in accordance with the ethical standards of the institution or practice at which the studies were conducted. For this type of study, formal consent is not required. This study was approved by the Clinical Research Ethics Committee of the Bellvitge University Hospital (study code EPA019/15).

Electronic supplementary material

Below is the link to the electronic supplementary material.

Figure 1

Pre-defined list of admission diagnoses that are potential adverse drug reactions. (DOC 48 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pedrós, C., Formiga, F., Corbella, X. et al. Adverse drug reactions leading to urgent hospital admission in an elderly population: prevalence and main features. Eur J Clin Pharmacol 72, 219–226 (2016). https://doi.org/10.1007/s00228-015-1974-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00228-015-1974-0

Keywords

Search

Navigation