Meta-analysis of Interventions to Reduce Adverse Drug Reactions in Older Adults

Overview

Journal J Am Geriatr Soc

Specialty Geriatrics

Date 2017 Dec 22

PMID 29265170

Citations 33

Authors

Shelly L Gray

Laura A Hart

Subashan Perera

Todd P Semla

Kenneth E Schmader

Joseph T Hanlon

Affiliations

Soon will be listed here.

Abstract

Objectives: To examine the effect of interventions to optimize medication use on adverse drug reactions (ADRs) in older adults.

Design: Systematic review and meta-analysis. EMBASE, PubMed, OVID, Cochrane Library, Clinicaltrials.gov, and Google Scholar were searched through April 30, 2017.

Setting: Randomized controlled trials.

Participants: Older adults (mean age ≥65) taking medications.

Measurements: Two authors independently extracted relevant information and assessed studies for risk of bias. Discrepancies were resolved in consensus meetings. The outcomes were any and serious ADRs. Random-effects models were used to combine the results of multiple studies and create summary estimates.

Results: Thirteen randomized controlled trials involving 6,198 older adults were included. The studies employed a number of different interventions that were categorized as pharmacist-led interventions (8 studies), other health professional-led interventions (3 studies), a brief educational session (1 study), and a technology intervention (1 study). The intervention group was 21% less likely than the control group to experience any ADR (odds ratio (OR) = 0.79, 95% confidence interval (CI) = 0.62-0.99). In the six studies that examined serious ADRs, the intervention group was 36% less likely than the control group to experience a serious ADR (OR = 0.64, 95% CI = 0.42-0.98).

Conclusion: Interventions designed to optimize medication use reduced the risk of any and serious ADRs in older adults. Implementation of these successful interventions in healthcare systems may improve medication safety in older adults.

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References

OMahony D . Pharmacists and prevention of inappropriate prescribing in hospital. Age Ageing. 2016; 45(2):181-3. DOI: 10.1093/ageing/afw006. View

Trivalle C, Cartier T, Verny C, Mathieu A, Davrinche P, Agostini H . Identifying and preventing adverse drug events in elderly hospitalised patients: a randomised trial of a program to reduce adverse drug effects. J Nutr Health Aging. 2010; 14(1):57-61. DOI: 10.1007/s12603-010-0010-4. View

Hanlon J, Weinberger M, Samsa G, Schmader K, Uttech K, Lewis I . A randomized, controlled trial of a clinical pharmacist intervention to improve inappropriate prescribing in elderly outpatients with polypharmacy. Am J Med. 1996; 100(4):428-37. DOI: 10.1016/S0002-9343(97)89519-8. View

Walsh K, ORiordan D, Kearney P, Timmons S, Byrne S . Improving the appropriateness of prescribing in older patients: a systematic review and meta-analysis of pharmacists' interventions in secondary care. Age Ageing. 2016; 45(2):201-9. DOI: 10.1093/ageing/afv190. View

Cooper J, Cadogan C, Patterson S, Kerse N, Bradley M, Ryan C . Interventions to improve the appropriate use of polypharmacy in older people: a Cochrane systematic review. BMJ Open. 2015; 5(12):e009235. PMC: 4679890. DOI: 10.1136/bmjopen-2015-009235. View

Willoch K, Blix H, Pedersen-Bjergaard A, Eek A, Reikvam A . Handling drug-related problems in rehabilitation patients: a randomized study. Int J Clin Pharm. 2012; 34(2):382-8. DOI: 10.1007/s11096-012-9623-5. View

DerSimonian R, Laird N . Meta-analysis in clinical trials. Control Clin Trials. 1986; 7(3):177-88. DOI: 10.1016/0197-2456(86)90046-2. View

Crotty M, Rowett D, Spurling L, Giles L, Phillips P . Does the addition of a pharmacist transition coordinator improve evidence-based medication management and health outcomes in older adults moving from the hospital to a long-term care facility? Results of a randomized, controlled trial. Am J Geriatr Pharmacother. 2005; 2(4):257-64. DOI: 10.1016/j.amjopharm.2005.01.001. View

Karch F, Lasagna L . Adverse drug reactions. A critical review. JAMA. 1975; 234(12):1236-41. View

10.

Gillespie U, Alassaad A, Henrohn D, Garmo H, Hammarlund-Udenaes M, Toss H . A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: a randomized controlled trial. Arch Intern Med. 2009; 169(9):894-900. DOI: 10.1001/archinternmed.2009.71. View

11.

Sonnichsen A, Trampisch U, Rieckert A, Piccoliori G, Vogele A, Flamm M . Polypharmacy in chronic diseases-Reduction of Inappropriate Medication and Adverse drug events in older populations by electronic Decision Support (PRIMA-eDS): study protocol for a randomized controlled trial. Trials. 2016; 17:57. PMC: 5526277. DOI: 10.1186/s13063-016-1177-8. View

12.

Riordan D, Walsh K, Galvin R, Sinnott C, Kearney P, Byrne S . The effect of pharmacist-led interventions in optimising prescribing in older adults in primary care: A systematic review. SAGE Open Med. 2016; 4:2050312116652568. PMC: 4910534. DOI: 10.1177/2050312116652568. View

13.

Maher R, Hanlon J, Hajjar E . Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2013; 13(1):57-65. PMC: 3864987. DOI: 10.1517/14740338.2013.827660. View

14.

Schmader K, Hanlon J, Pieper C, Sloane R, Ruby C, Twersky J . Effects of geriatric evaluation and management on adverse drug reactions and suboptimal prescribing in the frail elderly. Am J Med. 2004; 116(6):394-401. DOI: 10.1016/j.amjmed.2003.10.031. View

15.

Gurwitz J, Field T, Rochon P, Judge J, Harrold L, Bell C . Effect of computerized provider order entry with clinical decision support on adverse drug events in the long-term care setting. J Am Geriatr Soc. 2008; 56(12):2225-33. DOI: 10.1111/j.1532-5415.2008.02004.x. View

16.

Kwint H, Faber A, Gussekloo J, Bouvy M . Effects of medication review on drug-related problems in patients using automated drug-dispensing systems: a pragmatic randomized controlled study. Drugs Aging. 2011; 28(4):305-14. DOI: 10.2165/11586850-000000000-00000. View

17.

Liberati A, Altman D, Tetzlaff J, Mulrow C, Gotzsche P, Ioannidis J . The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med. 2009; 151(4):W65-94. DOI: 10.7326/0003-4819-151-4-200908180-00136. View

18.

Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009; 151(4):264-9, W64. DOI: 10.7326/0003-4819-151-4-200908180-00135. View

19.

Naranjo C, Busto U, Sellers E, Sandor P, Ruiz I, Roberts E . A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981; 30(2):239-45. DOI: 10.1038/clpt.1981.154. View

20.

Gray S, Mahoney J, Blough D . Adverse drug events in elderly patients receiving home health services following hospital discharge. Ann Pharmacother. 1999; 33(11):1147-53. DOI: 10.1345/aph.19036. View