24In-Hospital Adverse Drug Reactions in Hospitalised Older Adults - A Systematic Review

Abstract

Introduction: Studies indicate 1 in 4 older people experience hospital- related adverse drug reactions [ADRs]. This systematic-review aims to evaluate in-hospital ADRs in hospitalised older-adults in terms of incidence, prevalence, most commonly involved drug classes, severity, and consequences. Methods: Using PRISMA methodology [PROSPERO CRD42018079095], we searched PubMed, Embase, Ebsco-CINAHL, Cochrane Library, library hosted sources, Google® scholar, and 'grey' literature, using terms; aged, ADRs, hospitalized, multi-morbid, polypharmacy and hospital-acquired. References of editorials and systematic reviews were hand searched. Studies of all languages and dates until 15/01/2018 were included. All studies reporting ADRs outcomes, ≥65 years, hospitalised at time of ADR occurrence were included. Two researchers screened all papers for inclusion, risk of bias and data extraction. Results: Initial search yielded 1721 abstracts, 200 underwent full text screening. 60 were potentially suitable for inclusion; 48 papers reported combined ages, 12 papers reported directly on ADRs in our age cohort [2 papers reported the same data]. 11 studies [4424 patients] were analysed; 24% [1064] experienced ADRs. 7 reported severity (n = 707); 31% [220] being severe. 5 reported on post-ADR outcomes i.e. length of stay [n = 3], death [n = 1] and functional decline [n = 1]. Frequency of culprit drug-groups were described in 6 [672 ADRs]; 43% [291] cardiovascular system, 17% [114] central nervous system, 16% [112] clotting pathways, 13% [90] antimicrobials. Conclusions: One in four over 65 years experience an ADR during hospitalisation, one third being severe, and almost half cardiovascular system drugs. Clinical outcomes associated with ADRs are generally poorly described in the literature.