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Risk Factors Associated with Adverse Drug Reactions in Nursing Home Residents

Purpose: To identify risk factors associated with adverse drug reactions in a nursing home resident based on the study of Field et al.

Description

Field et al identified risk factors associated with adverse drug reactions in nursing home residents. These can help identify patients who should be reviewed for means to reduce these risks. The authors are from the University of Massachusetts, Brigham and Women's Hospital, Harvard Medical School and Cambridge Hospital.


Factors affecting risk of an adverse drug effect:

(1) general factors

(2) specific medications

(3) nutrition

 

General Factors Increasing Risk of an Adverse Drug Event

Having an Adverse Drug Event

Having a Preventable Adverse Drug Event

number of regular medications >= 5

x

x

being a new resident (<= 60 days)

x

 

increased comorbidity (Charlson Comorbidity Index >=5

 

x

 

 

Medications Increasing Risk of Adverse Drug Event

Having an Adverse Drug Event

Having a Preventable Adverse Drug Event

opioids

 

x

antipsychotic

x

x

anti-infective

x

x

antiepileptic

 

x

antidepressant

x

x

 

Factors decreasing the risk of an adverse drug event:

(1) taking nutrients or supplements

(2) male gender (for preventable adverse drug event)

 

where:

• I would think taking no regular medications would reduce the risk, although in the study patients taking 0 to 4 medications were combined into 1 group.

 

Risk Factor for Having an Adverse Drug Event

Odds Ratio

95% CI

antipsychotic

3.2

2.1 – 4.9

anti-infective agent

4.0

2.5 – 6.2

antidepressant

1.5

1.1 – 2.3

regular medications, 5 or 6

2.0

1.2 – 3.2

regular medications, 7 or 8

2.8

1.7 – 4.7

regular medications, >= 9

3.3

1.9 – 5.6

new resident

2.8

1.5 – 5.2

nutrients or supplements

0.42

0.27 – 0.63

from Table 3, page 1633

 

Risk Factor of Preventable Adverse Drug Event

Odds Ratio

95% CI

opioids

6.6

2.3 – 19.3

antipsychotic

4.0

2.2 – 7.3

anti-infective agent

3.0

1.6 – 5.8

antiepileptic

2.2

1.1 – 4.5

antidepressant

2.0

1.1 – 3.5

Charlson Comorbidity >= 5

2.6

1.1 – 6.0

regular medications, 5 or 6

1.7

0.83 – 3.5

regular medications, 7 or 8

3.2

1.4 – 6.9

regular medications, >= 9

2.9

1.3 – 6.8

nutrients or supplements

0.27

0.14 – 0.50

male gender

0.55

0.30 – 0.99

from Table 5, page 1634


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Specialty

Objective

ICD-10