This paper reviews articles from the past year that examined medication mishaps (i.e., medication errors and adverse drug events [ADEs]) in the elderly.
The MEDLINE and EMBASE databases were searched for English-language articles published in 2010 using a combination of search terms including: medication errors, medication adherence, medication compliance, suboptimal prescribing, monitoring, adverse drug events, adverse drug withdrawal events, therapeutic failures, and aged. A manual search of the reference lists of the identified articles and the authors’ article files, book chapters and recent reviews was conducted to identify additional publications. Five studies of note were selected for annotation and critique. From this literature search, this paper also provides a selected bibliography of manuscripts published in 2010 (excluding those previously published in the American Journal of Geriatric Pharmacotherapy or by one of the authors) that address various types of medication errors and ADEs in the elderly.
Three studies addressed types of medication errors. One study examined underuse (due to prescribing) as a type of medication error. This was a before-and-after study from the Netherlands reported that those who received comprehensive geriatric assessments had a reduction in the rate of under-treatment of chronic conditions over a third (from 32.9% to 22.3%, p < 0.05). A second study focused on reducing medication errors due to the prescribing of potentially inappropriate medications. This quasi-experimental study found that a computerized provider order entry clinical decision support system decreased the number of potentially inappropriate medications ordered for patient’s ≥ 65 years of age who were hospitalized (11.56 before to 9.94 orders per day after, p < 0.001). The third medication error study was a cross-sectional phone survey of managed-care elders. This study found that more blacks than whites had low antihypertensive medication adherence as per a self-reported measure (18.4% vs. 12.3% respectively; p < 0.001). Moreover, blacks compared to whites used more complementary and alternative medicine (CAM) for the treatment of hypertension (30.5% vs. 24.7%, respectively; p = 0.005). In multivariable analyses stratified by race, among blacks, those that used CAM were more likely than those that did not to have low antihypertensive medication adherence (prevalence rate ratio 1.56, 95% confidence interval 1.14–2.15, p= 0.006).
The remaining two articles each addressed some form of medication adverse events. A case-control study of Medicare Advantage patients revealed for the first time that skeletal muscle relaxant use was significantly associated with an increased fracture risk (adjusted odds ratio 1.40, 95% confidence interval 1.15–1.72; p < 0.001). This increased risk was even more pronounced with the concomitant use of benzodiazepines. Finally, a randomized controlled trial across 16 centers in France used a one-week educational intervention about high-risk medications and ADEs directed at rehabilitation health care teams. They found that the rate of ADEs in the intervention group was lower than that in the usual care group (22% vs. 36%, respectively, p = 0.004).
Information from these studies may be used to advance health professionals’ understanding of medication errors and ADEs and may help guide research and clinical practices in years to come.
Keywords: medication errors, suboptimal prescribing, medication adherence, drug monitoring, adverse drug events, aged