Drug related medical emergencies in the elderly: role of adverse drug reactions and non-compliance

• Published in: Postgraduate medical journal Vol. 77; no. 913; pp. 703 - 707
• Main Authors: Malhotra, S, Karan, R S, Pandhi, P, Jain, S
• Format: Journal Article
• Language: English
• Published: London The Fellowship of Postgraduate Medicine 01-11-2001; BMJ; BMJ Publishing Group Ltd; Oxford University Press; BMJ Group
• Subjects: Adverse and side effects; adverse drug reactions; Age; Aged; Aged, 80 and over; Biological and medical sciences; Care and treatment; Causes of; Compliance; Complications and side effects; Drug dosages; Drug Interactions; Drug intoxications. Doping; drug related medical emergencies; Drug-Related Side Effects and Adverse Reactions; Drugs; elderly; Emergencies; Emergency Service, Hospital; Female; Geriatrics; Humans; Interviews; Laboratories; Logistic Models; Male; Medical emergencies; Medical records; Medical sciences; non-compliance; Odds Ratio; Older people; Original; Pharmacology. Drug treatments; Polypharmacy; Prescription Fees; Prospective Studies; Risk Factors; Sex Factors; Studies; Substance abuse treatment; Treatment Refusal; Human; Drug; Intensive care; Emergency department; Toxicity; Hospital admission; Drug intoxication; Cause; Elderly
• ISSN: 0032-5473; 1469-0756
• DOI: 10.1136/pmj.77.913.703

BACKGROUND Adverse drug reactions and non-compliance are important causes of admissions in the elderly to medical clinics. The contribution of adverse drug reactions and non-compliance to admission by the medical emergency department was analysed. METHODS A total of 578 consecutive elderly patients admitted to the medical emergency department were interviewed to determine the percentage of admissions due to adverse drug reactions or non-compliance with medication regimens, their causes, consequences, and predictors. RESULTS Eighty three (14.4%) of the 578 admissions were drug related: 39 (6.7%) caused by adverse drug reactions and 44 (7.6%) caused by non-compliance with medication. One hundred ninety two (33.2%) patients had a history of non-compliance. Factors associated with an increased risk of admission because of an adverse drug reaction were patients with diabetes or neoplasms, and patients using numerous different medications. Factors associated with a higher risk of hospitalisation because of non-compliance were poor recall of the medication regimen, seeing numerous physicians, female sex, polypharmacy, drug costs, and switching over to non-conventional forms of treatment. CONCLUSION Many elderly admissions are drug related, with non-compliance accounting for a substantial fraction of these. Elderly people at high risk of suffering a drug related medical emergency are identified and suitable interventions may be planned by the healthcare policymakers to target them.