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Medication Errors in Aging Adults: A Case-Based Approach to Medication Management

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Geriatric Emergencies
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Abstract

Medication errors and adverse drug events can lead to emergency department visits and hospitalizations. Polypharmacy, drug-drug interactions, and incomplete medication histories can lead to the use of potentially inappropriate medications in elderly patients. Physiologic changes in geriatric patients impact medication response and must be considered during prescribing. Elderly patients are at higher risk for adverse drug events from multiple classes of medications, including CNS depressants and anticoagulants. Practical approaches to preventing medication errors in the elderly include obtaining accurate medication histories, recognizing high-risk medications, which should be avoided, and involving a pharmacist in the care of geriatric patients.

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References

  1. Murray MD, Callahan CM. Improving medication use for older adults: an integrated research agenda. Ann Intern Med. 2003;139:425–9.

    Article  PubMed  Google Scholar 

  2. Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med. 2011;365:2002.

    Article  CAS  PubMed  Google Scholar 

  3. Salvi F, Rossi L, Lattanzio F, Cheruini A. Intern Emerg Med. 2017;12(2):213–20.

    Article  PubMed  Google Scholar 

  4. Hohl CM, Dankoff J, Colacone A, et al. Polypharmacy, adverse drug-related events and potential adverse drug interactions in elderly patients presenting to an emergency department. Acad Emerg Med. 2002;9:1162–7.

    Article  Google Scholar 

  5. Trevisan C, Di Gregorio P, Debiasi E, et al. Factors influencing short-term outcomes for older patients accessing emergency departments after a fall: the role of fall dynamics. Gait Posture. 2017;58:463–8.

    Article  PubMed  Google Scholar 

  6. Holbrook AM, Pereira JA, Labiris R, et al. Systematic overview of warfarin and its drug and food interactions. Arch Intern Med. 2005;165:1095.

    Article  CAS  PubMed  Google Scholar 

  7. The American Geriatrics Society 2015 Beers Criteria Update Expert Panel. AGS Updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63:2227–46.

    Article  Google Scholar 

  8. Hilmer SN, Mager DE, Simonsick EM, Cao Y, Ling SM, Windham BG, Harris TB, Hanlon JT, Rubin SM, Shorr RI, Bauer DC, Abernethy DR. A drug burden index to define the functional burden of medications in older people. Arch Intern Med. 2007;167(8):781.

    Article  PubMed  Google Scholar 

  9. Fick DM, Waller JL, Maclean JR, et al. Potentially inappropriate medication use in a Medicare managed care population: association with higher costs and utilization. J Manag Care Pharm. 2001;7:407–13.

    Google Scholar 

  10. Perri M III, Menon AM, Deshpande AD, et al. Adverse outcomes associated with inappropriate drug use in nursing homes. Ann Pharmacother. 2005;39:405–11.

    Article  PubMed  Google Scholar 

  11. Lau DT, Kasper JD, Potter DE, et al. Hospitalization and death associated with potentially inappropriate prescriptions among elderly nursing home residents. Arch Intern Med. 2005;165:68–74.

    Article  PubMed  Google Scholar 

  12. Nahin RL, Pecha M, Welmerink DB, et al. Concomitant use of prescription drugs and dietary supplements in ambulatory elderly people. J Am Geriatr Soc. 2009;57:1197.

    Article  PubMed  Google Scholar 

  13. Eisenberg DM, Kessler RC, Foster C, et al. Unconventional medicine in the United States. Prevalence, costs, and patterns of use. N Engl J Med. 1993;328:246.

    Article  CAS  PubMed  Google Scholar 

  14. Tinetti ME, Bogardus ST Jr, Agostini JV. Potential pitfalls of disease-specific guidelines for patients with multiple conditions. N Engl J Med. 2004;351:2870.

    Article  CAS  PubMed  Google Scholar 

  15. Chew ML, Mulsant BH, Pollock BG, et al. Anticholinergic activity of 107 medications commonly used by older adults. J Am Geriatr Soc. 2008;56:1333.

    Article  PubMed  Google Scholar 

  16. Wieloch M, Själander A, Frykman V, et al. Anticoagulation control in Sweden: reports of time in therapeutic range, major bleeding, and thrombo-embolic complications from the national quality registry AuriculA. Eur Heart J. 2011;32:2282.

    Article  CAS  PubMed  Google Scholar 

  17. Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis, I: psychotropic drugs. J Am Geriatr Soc. 1999;47:30–9.

    Article  CAS  PubMed  Google Scholar 

  18. Ensrud KE, Blackwell TL, Mangione CM, et al. Central nervous system-active medications and risk for falls in older women. J Am Geriatr Soc. 2002;50:1629–37.

    Article  PubMed  Google Scholar 

  19. Ray WA, Thapa PB, Gideon P. Benzodiazepines and the risk of falls in nursing home residents. J Am Geriatr Soc. 2000;48:682–5.

    Article  CAS  PubMed  Google Scholar 

  20. Neutel CI, Hirdes JP, Maxwell CJ, et al. New evidence on benzodiazepine use and falls: the time factor. Age Ageing. 1996;5:273–8.

    Article  Google Scholar 

  21. Hampton LM, Daubresse M, Chang HY, Alexander GC, Budnitz DS. Emergency department visits by adults for psychiatric medication adverse events. JAMA Psychiat. 2014;71(9):1006–14.

    Article  Google Scholar 

  22. Griffin MR, Piper JM, Daugherty JR, et al. Nonsteroidal anti-inflammatory drug use and increased risk for peptic ulcer disease in elderly persons. Ann Intern Med. 1991;114:257.

    Article  CAS  PubMed  Google Scholar 

  23. Gurwitz JH, Soumerai SB, Avorn J. Improving medication prescribing and utilization in the nursing home. J Am Geriatr Soc. 1990;38:542.

    Article  CAS  PubMed  Google Scholar 

  24. Mamdani M, Juurlink DN, Lee DS, et al. Cyclo-oxygenase-2 inhibitors versus non-selective non-steroidal anti-inflammatory drugs and congestive heart failure outcomes in elderly patients: a population-based cohort study. Lancet. 2004;363:1751.

    Article  CAS  PubMed  Google Scholar 

  25. Ferrell BA. Pain management. In: Hazzard WR, Blass JP, Ettinger Jr WH, et al., editors. Principles of geriatric medicine and gerontology. 4th ed. New York: McGraw-Hill Companies; 1999. p. 413–33.

    Google Scholar 

  26. Shelton PS, Fritsch MA, Scott MA. Assessing medication appropriateness in the elderly: a review of available measures. Drugs Aging. 2000;16:437–50.

    Article  CAS  PubMed  Google Scholar 

  27. Cho S, et al. Geriatric drug evaluation. Arch Intern Med. 2011;171(10):936–40.

    Article  Google Scholar 

  28. Dean M. Opioids in renal failure and dialysis patients. J Pain Symptom Manag. 2004;28(5):497–504.

    Article  CAS  Google Scholar 

  29. Terrell KM, Heard K, Miller DK. Prescribing to older ED patients. Am J Emerg Med. 2006;24:468–78.

    Article  PubMed  Google Scholar 

  30. Bogunovic OJ, Greenfield SF. Use of benzodiazepines among elderly patients. Psychiatr Serv. 2004;55(3):233–5.

    Article  PubMed  Google Scholar 

  31. Brody AA, Gibson B, Tresner-Kirsch D, Kramer H, Thraen I, Coarr ME, Rupper R. High prevalence of medication discrepancies between home health referrals and Centers for Medicare and Medicaid Services home health certification and plan of care and their potential to affect safety of vulnerable elderly adults. J Am Geriatr Soc. 2016;64(11):e166–70.

    Article  PubMed  Google Scholar 

  32. Kwan JL, Lo L, Sampson M, Shojania KG. Medication reconciliation during transitions of care as a patient safety strategy: a systematic review. Ann Intern Med. 2013;158(5 Pt 2):397–403.

    Article  PubMed  Google Scholar 

  33. Hastings SN, Schmader KE, Sloane RJ, et al. Quality of pharmacotherapy and outcomes for older veterans discharged from the emergency department. J Am Geriatr Soc. 2008;56(5):875–80.

    Article  PubMed  Google Scholar 

  34. Shrank WH, Polinski JM, Avron J. Quality indicators for medication use in vulnerable elders. JAGS. 2007;55(52):S373–82.

    Article  Google Scholar 

  35. Dudas V, et al. The impact of follow-up telephone calls to patients after hospitalization. Am J Med. 2001;111(9 suppl 2):26S–30S.

    Article  CAS  PubMed  Google Scholar 

  36. Jack BW, et al. A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med. 2009;150:178–87.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Stewart S, Pearson S, Horowitz JD. Effects of a home-based intervention among patients with congestive heart failure discharged from acute hospital care. Arch Intern Med. 1998;158:1067–72.

    Article  CAS  PubMed  Google Scholar 

  38. Koehler BE, Richter KM, Youngblood L, et al. Reduction of 30-day postdischarge hospital readmission or emergency department (ED) visit rates in high risk elderly medical patients through delivery of a targeted care bundle. J Hosp Med. 2009;4:211–8.

    Article  PubMed  Google Scholar 

  39. Zillich AJ, Snyder ME, Frail CK, et al. A randomized, controlled pragmatic trial of telephonic medication therapy management to reduce hospitalization in home health patients. Health Serv Res. 2014;49:1537–54.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Moss JM, et al. Impact of clinical pharmacy specialists on the design and implementation of a quality improvement initiative to decrease inappropriate medications in a veterans affairs emergency department. JMCP. 2016;22(1):74–80.

    Article  PubMed  Google Scholar 

  41. Haag JD, et al. Impact of pharmacist-provided medication therapy management on healthcare quality and utilization in recently discharged elderly patients. Am Health Drug Benefits. 2016;9(5):259–68.

    PubMed  PubMed Central  Google Scholar 

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Correspondence to Abbie Lyden .

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Lyden, A., Allen, K. (2019). Medication Errors in Aging Adults: A Case-Based Approach to Medication Management. In: Lindquist, L., Dresden, S. (eds) Geriatric Emergencies. Springer, Cham. https://doi.org/10.1007/978-3-030-12414-4_7

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  • DOI: https://doi.org/10.1007/978-3-030-12414-4_7

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-12413-7

  • Online ISBN: 978-3-030-12414-4

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