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. 2023 Feb 23;73(728):e211-e219.
doi: 10.3399/BJGP.2022.0181. Print 2023 Mar.

Adverse drug reactions and associated patient characteristics in older community-dwelling adults: a 6-year prospective cohort study

Ann S Doherty  1 , Fiona Boland  2 , Frank Moriarty  3 , Tom Fahey  1 , Emma Wallace  4
Affiliations

Adverse drug reactions and associated patient characteristics in older community-dwelling adults: a 6-year prospective cohort study

Ann S Doherty et al. Br J Gen Pract. .

Abstract

Background: To date, research on adverse drug reactions (ADRs) has focused on secondary care, and there is a paucity of studies that have prospectively examined ADRs affecting older adults in general practice.

Aim: To examine the cumulative incidence and severity of ADRs and associated patient characteristics in a sample of community-dwelling older adults.

Design and setting: Prospective cohort study of older adults (aged ≥70 years, N = 592) recruited from 15 general practices in the Republic of Ireland.

Method: Manual review of the participant's general practice electronic medical record, linked to the national dispensed prescription medicine database, and a detailed, self-reported patient postal questionnaire. The primary outcomes were ADR occurrence and severity over a 6-year period (2010-2016). Unadjusted and adjusted logistic regression models examined potential associations between patient characteristics and ADR occurrence.

Results: A total of 211 ADRs were recorded for 159 participants, resulting in a cumulative incidence of 26.9% over 6 years. The majority of ADRs detected were mild (89.1%), with the remainder classified as moderate (10.9%). Eight moderate ADRs, representing 34.8% of moderate ADRs and 3.8% of all ADRs, required an emergency hospital admission. ADRs were independently associated with female sex (adjusted odds ratio [OR] 1.83, 95% confidence interval [CI] = 1.17 to 2.85; P = 0.008), polypharmacy (5-9 drug classes) (adjusted OR 1.81, 95% CI = 1.17 to 2.82; P = 0.008), and major polypharmacy (≥10 drug classes) (adjusted OR = 3.33, 95% CI = 1.62 to 6.85; P = 0.001).

Conclusion: This prospective cohort study of ADRs in general practice shows that over one-quarter of older adults experienced an ADR over a 6-year period. Polypharmacy is independently associated with ADR risk in general practice and older adults on ≥10 drug classes should be prioritised for regular medication review.

Keywords: adverse drug reaction; drug-related side effects and adverse reactions; electronic health records; general practice; older adults; polypharmacy.

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Figures

Figure 1.
Figure 1.
Study flow diagram (2010–2016) describing losses to follow-up. aHospice, n = 2; long-stay inpatient, n = 3.
See this image and copyright information in PMC

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