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

Ann S Doherty; Fiona Boland; Frank Moriarty; Tom Fahey; Emma Wallace

doi:10.3399/BJGP.2022.0181

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

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

Authors

Ann S Doherty¹, Fiona Boland², Frank Moriarty³, Tom Fahey¹, Emma Wallace⁴

Affiliations

¹ Health Research Board (HRB) Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin.
² HRB Centre for Primary Care Research, Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland; Data Science Centre, RCSI University of Medicine and Health Sciences, Dublin.
³ School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin.
⁴ HRB Centre for Primary Care Research, Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin; Department of General Practice, University College Cork, Cork.

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.

MeSH terms

Aged
Drug-Related Side Effects and Adverse Reactions* / epidemiology
Female
Hospitalization
Humans
Independent Living*
Polypharmacy
Prospective Studies
Risk Factors