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
Purpose: To evaluate the drug therapy of an older adult using the anticholinergic risk scale of Rudolph et al.
Specialty: Toxicology, Emergency Medicine, Critical Care
Objective: risk factors, adverse effects
ICD-10: T50.9,