title: Medication misadventures in older adults: literature from 2013.
abstract: The objective of this paper is to review articles published in 2013 examining drug-related problems in the elderly and comment on their potential impact on clinical practice. To identify articles, we did a systematic search of the English-language literature restricted to those aged 65 + from January 2013 to December 2013 using Medline and Google Scholar and a combination of the following search terms: drug-related problems, medication-related problems, medication errors, suboptimal prescribing, inappropriate prescribing, underutilization, polypharmacy, medication monitoring, medication dispensing, medication administration, medication adherence, adverse drug events, and adverse drug withdrawal events. A manual search of major general medicine and clinical pharmacology journals was also conducted to identify additional articles. A total of 51 articles were identified of which 20 were chosen to highlight. Three were annotated and critiqued and the additional 17 articles were summarized in an appendix. One article reported the results of a randomized controlled trial that showed that a pharmacist intervention successfully reduced suboptimal prescribing in older hospital patients. Another paper from this group previously reported data from the same study showing that the intervention also reduced medication related readmissions to the hospital. An observational study compared the use of two thiazide diuretics in older outpatients. They found that chlorthalidone was more likely to cause hypokalemia than hydrochlorothiazide. Finally, in a randomized controlled trial a pharmacist intervention resulted in the reduction of anticholinergic burden but did result in an improvement in cognition. These studies highlight that medication errors and adverse drug events continue to be important issues for health care professionals caring for older adults.
authors.affiliation: Division of Geriatrics, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania; Geriatric Pharmaceutical Outcomes and Gero-Informatics Research and Training Program, University of Pittsburgh, Pittsburgh, Pennsylvania; Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania; Geriatric Research, Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Hanlon
authors.forename: Todd P
authors.initials: TP
authors.lastname: Semla
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Schmader
mesh_terms: D000368:Aged; D064807:Anticholinergic Syndrome / Q000517:prevention & control; D018680:Cholinergic Antagonists / Q000009:adverse effects; D002986:Clinical Trials as Topic; D003072:Cognition Disorders / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D059065:Medication Reconciliation; D010595:Pharmacists; D024382:Professional Role; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use
chemical_list: D018680:Cholinergic Antagonists; D049993:Sodium Chloride Symporter Inhibitors
keywords: adverse drug events; age; medication errors; pharmacoepidemiology