Medicina Rotigotina

Páginas: 14 (3483 palabras) Publicado: 21 de agosto de 2011
DOI:10.1111/j.1365-2125.2006.02831.x

British Journal of Clinical Pharmacology

Is inappropriate medication use a major cause of adverse drug reactions in the elderly?
Marie-Laure Laroche, Jean-Pierre Charmes,1 Yves Nouaille, Nicolas Picard & Louis Merle Department of Pharmacology-Toxicology, University Hospital Dupuytren and 1Department of Geriatrics, Hospital Rebeyrol, Limoges, FranceWhat is already known about this subject • Several studies have shown that inappropriate medications induce adverse health outcomes in the elderly. • The hypothesis of Beers et al. that these inappropriate medications increase the likelihood of adverse drug reactions is debated and checked in patients admitted to hospital.

What this study adds • Inappropriate medications do not seem to be themajor cause of adverse drug reactions in the elderly. • More than the inappropriateness of the drugs themselves, it is the inappropriate use of drugs that is to be tackled when treating the elderly. • The main preventable factor is the reduction in the number of drugs given.

Correspondence Professor Louis Merle, Pharmacologie-Toxicologie, Hôpital Dupuytren, 87042 Limoges, France. Tel.: + 33 55505 6743 Fax: + 33 5 5505 6162 E-mail: louis.merle@chu-limoges.fr
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Aim To study the occurrence of adverse drug reactions (ADRs) linked to inappropriate medication (IM) use in elderly people admitted to an acute medical geriatric unit. Methods All the elderly people aged 70years admitted to the acute medical geriatric unit of Limoges University hospital (France) over a 49-month period were included, whatever their medical condition. For all the patients, clinical pharmacologists listed the medications given before admission and identified the possible ADRs. The appropriateness of these medications and the causal relationship between drugs (either appropriate ornot) and ADRs were evaluated. Results Two thousand and eighteen patients were included. The number of drugs taken was 7.3 3.0 in the patients with ADRs and 6.0 3.0 in those without ADRs (P < 0.0001). Sixty-six percent of the patients were given at least one IM prior to admission. ADR prevalence was 20.4% among the 1331 patients using IMs and 16.4% among those using only appropriate drugs (P < 0.03).In only 79 of the 1331 IM users (5.9%) were ADRs directly attributable to IMs. The IMs most often involved in patients with ADRs were: anticholinergic antidepressants, cerebral vasodilators, long-acting benzodiazepines and concomitant use of two or more psychotropic drugs from the same therapeutic class. Using multivariate analysis, after adjusting for confounding factors, IM use was notassociated with a significant increased risk of ADRs (odds ratio 1.0, 95% confidence interval 0.8, 1.3). Conclusion Besides a reduction in the number of drugs given to the elderly, a good prescription should involve a reduction in the proportion of IMs and should take into consideration the frailty of these patients.

Keywords adverse drug reaction, elderly, inappropriate medication.............................................................................................................................

Received 29 May 2006 Accepted 6 October 2006 Published OnlineEarly 7 December 2006

© 2006 The Authors Journal compilation © 2006 Blackwell Publishing Ltd

Br J Clin Pharmacol

63:2

177–186

177

M-L. Laroche et al.

Introduction

Adverse drug reactions (ADRs) in olderpeople are a major public health issue. The elderly are more likely to experience ADRs because of age-related changes in the pharmacokinetics and pharmacodynamics of the drugs they are given to treat their multiple pathological conditions. ADRs are up to seven times more frequent in 70–79-year-olds than in those aged 20–29 years [1]. In Europe, 20% of ambulatory elderly people suffer from ADRs;...
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