Risk Factors for Adverse Drug Events Among Older Adults in the Ambulatory Setting
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.
Search for more papers by this authorJerry 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.
Search for more papers by this authorLeslie 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.
Search for more papers by this authorJeffrey 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.
Search for more papers by this authorKristin 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.
Search for more papers by this authorAndrew 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.
Search for more papers by this authorJill 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.
Search for more papers by this authorLeslie 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.
Search for more papers by this authorCynthia 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.
Search for more papers by this authorLeslie 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.
Search for more papers by this authorLawrence 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.
Search for more papers by this authorMichael 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.
Search for more papers by this authorDavid 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.
Search for more papers by this authorTerry 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.
Search for more papers by this authorJerry 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.
Search for more papers by this authorLeslie 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.
Search for more papers by this authorJeffrey 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.
Search for more papers by this authorKristin 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.
Search for more papers by this authorAndrew 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.
Search for more papers by this authorJill 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.
Search for more papers by this authorLeslie 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.
Search for more papers by this authorCynthia 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.
Search for more papers by this authorLeslie 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.
Search for more papers by this authorLawrence 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.
Search for more papers by this authorMichael 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.
Search for more papers by this authorDavid 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.
Search for more papers by this authorSupported 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.
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