title: Adverse drug events in older patients admitted as an emergency: the role of potentially inappropriate medication in elderly people (PRISCUS).
abstract: BACKGROUND
  Lists of potentially inappropriate medications (PIMs) for the elderly, such as the German PRISCUS list, have been published as expert recommendations with the aim of improving drug safety for this patient group. In this study, we tried to determine how often adverse drug events occur in the emergency department and what role PRISCUS medications might play in these events.
  
  
  METHODS
  We prospectively reviewed the medical records of 752 patients who were treated in the emergency department (ED) of a level III hospital in Germany for adverse drug events due to medication errors (MEs) and for adverse drug reactions (ADRs). The evaluation was performed in two steps by pharmacologists, clinical pharmacologists, and board-certified internists.
  
  
  RESULTS
  Both clinically important MEs and ADRs became more common with advancing age. Among the 351 patients who were over age 65, 307 (87.5%) were taking at least one medication at home. Of these 307 patients, 16.6% (95% confidence interval [CI]: 12.9-21.2%) were taking at least one PIM, as defined by the German PRISCUS list. In relative terms, PIMs were more commonly associated with ADRs or MEs than other drugs (27.0% [95% CI: 17.5-39.1% versus 15.7% [95% CI: 14.1-17.4%], Odds ratio 1.99 [95% CI: 1.23-3.52: p = 0.018), but in absolute terms ADRs and MEs involved non-PIM more often than PIM.
  
  
  CONCLUSIONS
  Elderly patients more frequently suffer from ADR and from the clinical consequences of medication errors. Elderly patients taking PIMs are more likely to suffer from ADRs and MEs, even though most drug-related events are still attributable to non-PIM.
authors.affiliation: Department of Emergency Medicine, Hospital Fürth, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Dormann
authors.forename: Anja
authors.initials: A
authors.lastname: Sonst
authors.forename: Fabian
authors.initials: F
authors.lastname: Müller
authors.forename: Renate
authors.initials: R
authors.lastname: Vogler
authors.forename: Andrius
authors.initials: A
authors.lastname: Patapovas
authors.forename: Barbara
authors.initials: B
authors.lastname: Pfistermeister
authors.forename: Bettina
authors.initials: B
authors.lastname: Plank-Kiegele
authors.forename: Melanie
authors.initials: M
authors.lastname: Kirchner
authors.forename: Nina
authors.initials: N
authors.lastname: Hartmann
authors.forename: Thomas
authors.initials: T
authors.lastname: Bürkle
authors.forename: Renke
authors.initials: R
authors.lastname: Maas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data*; D015995:Prevalence; D018570:Risk Assessment