Reducing the Risk of Adverse Drug Events in Older Adults

The effects of medications in older adults are not often studied adequately, even though more than one-half of all prescription medications are dispensed to persons older than 60 years.¹ More than 90 percent of noninstitutionalized older adults in the United States take at least one prescription medication,² and those who are seen in the office take six to eight medications on average.^3-5

One in six hospital admissions of older adults is because of an adverse drug event,⁶ a proportion that is four times that of younger persons. For persons older than 75 years, hospital admissions because of an adverse drug event increase even further to one in three.^7,8 While in the hospital, one in six older patients experiences an adverse drug event.⁹ In the office and community settings, one in five older adults is taking potentially inappropriate medications.^3,5,10

There are five categories of adverse drug events: adverse drug reaction, medication error, therapeutic failure, adverse drug withdrawal event, and overdose.¹¹ Adverse drug reactions are the most common, accounting for three-fourths of hospitalizations from adverse drug events; the remainder are caused by nonadherence, or omission or cessation of treatment.⁷ The World Health Organization further identifies adverse drug events as unintended and undesired effects of a medication at the normal dose; therapeutic failures, overdoses, and medication abuse are excluded.^6,12

Reducing the risk of adverse drug events in older adults requires close monitoring of functional status, early identification of symptoms, and recognition of the impact a medication can have on multiple organ systems. Because of the many variables that must be considered in caring for older adults, clinical judgment is paramount.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendation	Evidence rating	References
The use of antipsychotics, antidepressants, benzodiazepines, and sedative/hypnotics in older adults should be limited to reduce the risk of falls.	C	31
The number of medications in older adults should be limited, because each new medication adds more than one adverse drug event each year and taking six or more medications increases this risk fourfold.	C	3, 4, 30
Ideally, the primary care physician should prescribe all medications, because each additional prescriber increases the risk of adverse drug...