In-hospital adverse drug reactions in older adults; prevalence, presentation and associated drugs—a systematic review and meta-analysis

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Show simple item record Jennings, Emma L. M. Murphy, Kevin D. Gallagher, Paul O'Mahony, Denis 2020-10-21T16:19:43Z 2020-10-21T16:19:43Z 2020-10-06
dc.identifier.citation Jennings, E. L. M., Murphy, K. D., Gallagher, P. and O’Mahony, D. (2020) 'In-hospital adverse drug reactions in older adults; prevalence, presentation and associated drugs—a systematic review and meta-analysis', Age and Ageing, afaa188, (11 pp). doi: 10.1093/ageing/afaa188 en
dc.identifier.endpage 1 en
dc.identifier.issn 0002-0729
dc.identifier.doi 10.1093/ageing/afaa188 en
dc.description.abstract Background: the prevalence of adverse drug reactions (ADRs) in hospitalised older patients, their clinical presentations, causative drugs, severity, preventability and measurable outcomes are unclear, ADRs being an increasing challenge to older patient safety. Methods: we systematically searched PubMed, Embase, EBSCO-CINAHL, the Cochrane Library, ‘rey’ literature and relevant systematic review bibliographies, published from database inception to March 2020. We included any study reporting occurrence of in-hospital ADRs as primary or secondary outcomes in hospitalised older adults (mean age ≥ 65 years). Two authors independently extracted relevant information and appraised studies for bias. Study characteristics, ADR clinical presentations, causative drugs, severity, preventability and clinical outcomes were analysed. Study estimates were pooled using random-effects meta-analytic models. Results: from 2,399 abstracts, we undertook full-text screening in 286, identifying 27 studies (29 papers). Final analysis yielded a pooled ADR prevalence of 16% (95%CI 12–22%, I2 98%,τ2 0.8585), in a population of 20,153 hospitalised patients aged ≥65 years of whom 2,479 patients experienced ≥ one ADR. ADR ascertainment was highly heterogeneous. Almost 48.3% of all ADRs involved five presentations: fluid/electrolyte disturbances (17.3%), gastrointestinal motility/defaecation disorders (13.3%), renal disorders (8.2%), hypotension/blood pressure dysregulation disorders/shock (5.5%) and delirium (4.1%). Four drug classes accounted for 57.8% of causative medications i.e. diuretics (19.8%), anti-bacterials (14.8%), antithrombotic agents (12.2%) and analgesics (10.9%). Pooled analysis of severity was not feasible. Four studies reported the majority of ADRs as preventable (55–95%). Conclusions: on average, 16% of hospitalised older patients experience significant ADRs, varying in severity and mostly preventable, with commonly prescribed drug classes accounting for most ADRs. en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher Oxford University Press en
dc.rights © The Author(s) 2020. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. This is the submitted pre-copyedited, author-produced PDF of an article accepted for publication in Age and Ageing. The version of record is available online at en
dc.subject Older people en
dc.subject Adverse drug reaction en
dc.subject Polypharmacy en
dc.subject Multi-morbidity en
dc.subject Inpatient en
dc.subject Iatrogenic en
dc.title In-hospital adverse drug reactions in older adults; prevalence, presentation and associated drugs—a systematic review and meta-analysis en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Kevin Murphy, School of Pharmacy, University College Cork, Cork, Ireland. +353-21-490-3000 Email: en
dc.internal.availability Full text available en 2020-10-15T08:00:24Z
dc.description.version Accepted Version en
dc.internal.rssid 540331817
dc.contributor.funder Horizon 2020 en
dc.description.status Peer reviewed en
dc.identifier.journaltitle Age and Ageing en
dc.internal.copyrightchecked Yes
dc.internal.licenseacceptance Yes en
dc.internal.IRISemailaddress en
dc.internal.IRISemailaddress en
dc.internal.IRISemailaddress en
dc.identifier.articleid 11 en
dc.internal.bibliocheck In press. Update citation. Add volume, page numbers. en
dc.relation.project info:eu-repo/grantAgreement/EC/H2020::RIA/634238/EU/OPtimising thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly/OPERAM en

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