Volume 52, Issue 8 p. 1349-1354

Risk Factors for Adverse Drug Events Among Older Adults in the Ambulatory Setting

Terry S. Field DSc

Terry S. Field DSc

From the * Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts Fallon Foundation, Worcester, Massachusetts Brigham and Women's Hospital and Partners HealthCare System, Boston, Massachusetts.

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Jerry H. Gurwitz MD

Jerry H. Gurwitz MD

From the * Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts Fallon Foundation, Worcester, Massachusetts Brigham and Women's Hospital and Partners HealthCare System, Boston, Massachusetts.

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Leslie R. Harrold MD, MPH

Leslie R. Harrold MD, MPH

From the * Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts Fallon Foundation, Worcester, Massachusetts Brigham and Women's Hospital and Partners HealthCare System, Boston, Massachusetts.

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Jeffrey Rothschild MD, MPH

Jeffrey Rothschild MD, MPH

From the * Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts Fallon Foundation, Worcester, Massachusetts Brigham and Women's Hospital and Partners HealthCare System, Boston, Massachusetts.

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Kristin R. DeBellis PharmD

Kristin R. DeBellis PharmD

From the * Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts Fallon Foundation, Worcester, Massachusetts Brigham and Women's Hospital and Partners HealthCare System, Boston, Massachusetts.

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Andrew C. Seger RPh

Andrew C. Seger RPh

From the * Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts Fallon Foundation, Worcester, Massachusetts Brigham and Women's Hospital and Partners HealthCare System, Boston, Massachusetts.

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Jill C. Auger RPh

Jill C. Auger RPh

From the * Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts Fallon Foundation, Worcester, Massachusetts Brigham and Women's Hospital and Partners HealthCare System, Boston, Massachusetts.

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Leslie A. Garber RPh

Leslie A. Garber RPh

From the * Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts Fallon Foundation, Worcester, Massachusetts Brigham and Women's Hospital and Partners HealthCare System, Boston, Massachusetts.

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Cynthia Cadoret

Cynthia Cadoret

From the * Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts Fallon Foundation, Worcester, Massachusetts Brigham and Women's Hospital and Partners HealthCare System, Boston, Massachusetts.

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Leslie S. Fish PharmD

Leslie S. Fish PharmD

From the * Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts Fallon Foundation, Worcester, Massachusetts Brigham and Women's Hospital and Partners HealthCare System, Boston, Massachusetts.

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Lawrence D. Garber MD

Lawrence D. Garber MD

From the * Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts Fallon Foundation, Worcester, Massachusetts Brigham and Women's Hospital and Partners HealthCare System, Boston, Massachusetts.

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Michael Kelleher MD

Michael Kelleher MD

From the * Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts Fallon Foundation, Worcester, Massachusetts Brigham and Women's Hospital and Partners HealthCare System, Boston, Massachusetts.

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David W. Bates MD, MSc

David W. Bates MD, MSc

From the * Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts Fallon Foundation, Worcester, Massachusetts Brigham and Women's Hospital and Partners HealthCare System, Boston, Massachusetts.

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First published: 19 July 2004
Citations: 213
Address correspondence to Terry S. Field, D.Sc., Meyers Primary Care Institute 630 Plantation Street Worcester, MA 01605. E-mail: [email protected]

Supported by research Grant AG 15979, cofunded by the National Institute on Aging and the Agency for Healthcare Research and Quality. The contents are solely the responsibility of the authors and do not necessarily reflect the official views of the National Institute on Aging.

Abstract

Objectives: To gather information on patient-level factors associated with risk of adverse drug events (ADEs) that may allow focus of prevention efforts on patients at high risk.

Design: Nested case-control study.

Setting: Large multispecialty group practice in New England.

Participants: All Medicare enrollees cared for by a multispecialty group practice during 1 year (N=30,397 person-years from July 1, 1999, through June 30, 2000). For each patient with an ADE, a control was randomly selected.

Measurements: Data were abstracted from medical records on age, sex, comorbidities, and medication use at the time of the event.

Results: ADEs were identified in 1,299 older adults. Independent risk factors included being female and aged 80 and older. There were dose-response associations with the Charlson Comorbidity Index and number of scheduled medications. Patients taking anticoagulants, antidepressants, antibiotics, cardiovascular drugs, diuretics, hormones, and corticosteroids were at increased risk. In the analysis of preventable ADEs, the dose-response relationship with comorbidity and number of medications remained. Patients taking nonopioid analgesics (predominantly nonsteroidal antiinflammatory drugs and acetaminophen), anticoagulants, diuretics, and anti-seizure medications were at increased risk.

Conclusion: Prevention efforts to reduce ADEs should be targeted toward older adults with multiple medical conditions or taking multiple medications, nonopioid analgesics, anticoagulants, diuretics, and antiseizure medications.