title: Adverse drug events after hospital discharge in older adults: types, severity, and involvement of Beers Criteria Medications.
abstract: OBJECTIVE
  To characterize adverse drug events (ADEs) occurring within the high-risk 45-day period after hospitalization in older adults.
  
  
  METHODS
  Clinical pharmacists reviewed the ambulatory records of 1,000 consecutive discharges.
  
  
  METHODS
  A large multispecialty group practice closely aligned with a Massachusetts-based health plan.
  
  
  METHODS
  Hospitalized individuals aged 65 and older discharged home.
  
  
  METHODS
  Possible drug-related incidents occurring during the 45-day period after hospitalization were identified and presented to a pair of physician-reviewers who classified incidents as to whether an ADE was present, whether the event was preventable, and the severity of the event. Medications implicated in ADEs were further characterized according to their inclusion in the 2012 Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.
  
  
  RESULTS
  At least one ADE was identified during the 45-day period in 18.7% (n = 187) of the 1,000 discharges. Of the 242 ADEs identified, 35% (n = 84) were deemed preventable, of which 32% (n = 27) were characterized as serious, and 5% (n = 4) as life threatening. More than half of all ADEs occurred within the first 14 days after hospitalization. The percentage of ADEs in which Beers Criteria medications were implicated was 16.5% (n = 40). Beers criteria medications with both a high quality of evidence and strong strength of recommendation were implicated in 6.6% (n = 16) of the ADEs.
  
  
  CONCLUSIONS
  ADEs are common and often preventable in older adults after hospital discharge, underscoring the need to address medication safety during this high-risk period in this vulnerable population. Beers criteria medications played a small role in these events, suggesting that efforts to improve the quality and safety of medication use during this critical transition period must extend beyond a singular focus on Beers criteria medications.
authors.affiliation: MCPHS University, Worcester, Massachusetts; Meyers Primary Care Institute, Worcester, Massachusetts; University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Abir O
authors.initials: AO
authors.lastname: Kanaan
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Donovan
authors.forename: Nerissa P
authors.initials: NP
authors.lastname: Duchin
authors.forename: Terry S
authors.initials: TS
authors.lastname: Field
authors.forename: Jennifer
authors.initials: J
authors.lastname: Tjia
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Cutrona
authors.forename: Shawn J
authors.initials: SJ
authors.lastname: Gagne
authors.forename: Lawrence
authors.initials: L
authors.lastname: Garber
authors.forename: Peggy
authors.initials: P
authors.lastname: Preusse
authors.forename: Leslie R
authors.initials: LR
authors.lastname: Harrold
authors.forename: Jerry H
authors.initials: JH
authors.lastname: Gurwitz
mesh_terms: D000368:Aged; D064420:Drug-Related Side Effects and Adverse Reactions / Q000145:classification / Q000453:epidemiology*; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing; D008297:Male; D010351:Patient Discharge; D012720:Severity of Illness Index; D013997:Time Factors
keywords: Beers medications; adverse drug events; ambulatory care setting; older adults