Risk factors for adverse drug events among older adults in the ambulatory setting.
OBJECTIVE
To gather information on patient-level factors associated with risk of adverse drug events (ADEs) that may allow focus of prevention efforts on patients at high risk.


METHODS
Nested case-control study.


METHODS
Large multispecialty group practice in New England.


METHODS
All Medicare enrollees cared for by a multispecialty group practice during 1 year (N=30,397 person-years from July 1, 1999, through June 30, 2000). For each patient with an ADE, a control was randomly selected.


METHODS
Data were abstracted from medical records on age, sex, comorbidities, and medication use at the time of the event.


RESULTS
ADEs were identified in 1,299 older adults. Independent risk factors included being female and aged 80 and older. There were dose-response associations with the Charlson Comorbidity Index and number of scheduled medications. Patients taking anticoagulants, antidepressants, antibiotics, cardiovascular drugs, diuretics, hormones, and corticosteroids were at increased risk. In the analysis of preventable ADEs, the dose-response relationship with comorbidity and number of medications remained. Patients taking nonopioid analgesics (predominantly nonsteroidal antiinflammatory drugs and acetaminophen), anticoagulants, diuretics, and anti-seizure medications were at increased risk.


CONCLUSIONS
Prevention efforts to reduce ADEs should be targeted toward older adults with multiple medical conditions or taking multiple medications, nonopioid analgesics, anticoagulants, diuretics, and antiseizure medications.
Field
Terry S
TS
Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts 01605, USA. tfield@meyersprimary.org
Gurwitz
Jerry H
JH
Harrold
Leslie R
LR
Rothschild
Jeffrey
J
DeBellis
Kristin R
KR
Seger
Andrew C
AC
Auger
Jill C
JC
Garber
Leslie A
LA
Cadoret
Cynthia
C
Fish
Leslie S
LS
Garber
Lawrence D
LD
Kelleher
Michael
M
Bates
David W
DW
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects; D000925:Anticoagulants / Q000009:adverse effects; D000927:Anticonvulsants / Q000009:adverse effects; D016022:Case-Control Studies; D004232:Diuretics / Q000009:adverse effects; D004359:Drug Therapy, Combination; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors; D012737:Sex Factors
D018712:Analgesics, Non-Narcotic; D000925:Anticoagulants; D000927:Anticonvulsants; D004232:Diuretics