Avoiding ADEs

Thursday, January 10th, 2008
This post was written by Melanie Matthews

Adverse drug events (ADEs) are more apt to occur among older adults, as they are typically prescribed more medications and experience different effects from these drugs than younger people might. Statistics show that nearly 33 percent of older people who take at least five medications will experience an ADE each year. Of the 33 percent, nearly two-thirds will require some form of medical attention as a result of the ADE. Moreover, as much as 95 percent of these reactions are predictable, and over one-fourth percent are preventable, says Cung Pham, M.D., fellow in the Tufts University Family Medicine (TUSM) Residency at Cambridge Health Alliance’s Malden Family Medicine Center, and Robert Dickman, M.D., Jaharis Family Chair of Family Medicine at TUSM.

Published in American Family Physician, TUSM offers steps that all healthcare providers can take to avoid overuse, misuse and underuse of medication in older adults, and ultimately reduce ADEs as a whole. Highlights of the report include:

  • Avoiding misuse of medications: If a drug is listed on the Beers Criteria, a widely-adopted list of drugs that labels medications as “potentially inappropriate” for older persons or for older persons with specific medical conditions, the authors report that physicians can avoid those drugs apt to cause a severe adverse drug event simply by selecting alternatives. If there is no alternative, the best choice for a necessary drug is to start at the lowest effective dose and, when possible, discontinue the drug.
  • Avoiding overuse of medications: polypharmacy and overdosing Polymedicine describes the use of an increasing number of drugs related to an increasing number of medical problems, while polypharmacy is defined as inappropriate use of multiple drugs. While there is no standard marker for when a patient’s polymedicine list becomes polypharmacy, “increasing the number of medications increases the risk of drug-drug interactions and adverse drug events,” says Pham, “and reviews of medications should be routine.”
  • The “brown-bag” method, where patients bring all of their medications in a brown bag to the physician’s office, can lead to dropping at least one medicine in 20 percent of patients and a change in medication in 29 percent of patients.
  • Avoiding underuse of medication: underprescribing and nonadherence “Despite concerns about overprescribing, many conditions remain underdiagnosed or undertreated,” write the authors. “Ascribing all symptoms to degenerative disease or old age will potentially miss treatable conditions,” including heart disease, depression, osteoporosis and pain.
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