title: Reducing the risk of adverse drug events in older adults.
abstract: Adverse drug events occur in 15 percent or more of older patients presenting to offices, hospitals, and extended care facilities. These events are potentially preventable up to 50 percent of the time. Common serious manifestations include falls, orthostatic hypotension, heart failure, and delirium. The most common causes of death are gastrointestinal or intracranial bleeding and renal failure. Antithrombotic and antidiabetic medications, diuretics, and nonsteroidal anti-inflammatory drugs cause most of the preventable hospital admissions due to adverse drug events. Strategies to reduce the risk of adverse drug events include discontinuing medications, prescribing new medications sparingly, reducing the number of prescribers, and frequently reconciling medications. The Beers, STOPP (screening tool of older persons' potentially inappropriate prescriptions), and START (screening tool to alert doctors to right treatment) criteria can help identify medications causing adverse drug events. Not all potentially inappropriate medications can be avoided. Clinicians should involve patients in shared decision making and individualize prescribing decisions based on medical, functional, and social conditions; quality of life; and prognosis.
authors.affiliation: Wright State University Boonshoft School of Medicine, Dayton, OH, USA.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Pretorius
authors.forename: Gordana
authors.initials: G
authors.lastname: Gataric
authors.forename: Steven K
authors.initials: SK
authors.lastname: Swedlund
authors.forename: John R
authors.initials: JR
authors.lastname: Miller
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems; D000368:Aged; D000369:Aged, 80 and over; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control*; D005260:Female; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D057970:Inappropriate Prescribing / Q000009:adverse effects / Q000517:prevention & control*; D008297:Male; D008508:Medication Errors / Q000009:adverse effects / Q000517:prevention & control* / Q000706:statistics & numerical data; D008875:Middle Aged; D019338:Polypharmacy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012307:Risk Factors; D040242:Risk Reduction Behavior; D014481:United States / Q000453:epidemiology