Adverse drug reactions in the elderly as a contributing factor for hospital admission
An article in the British Medical Journal, Vol. 315, Oct. 25 1997, reviewed adverse drug events (ADEs) as contributing factors for hospital admission in older adults. Two things are of interest in this article: 1) They calculated an Odds Ratio (OR), which is the statistical correlation between events or variables, of 51.3 between severe ADEs and falls. (An example of a severe ADE is gastrointestinal bleeding or internal hemorrhage) The higher the OR the stronger the correlation. Putting that into perspective, leg weakness has an OR of 4.4 when correlated with falls, cognitive impairment has an OR of 1.8, gait deficits 2.9, balance deficits 2.9 and over age of 80 carrying an OR of 1.7. That means that severe ADEs are closely tied to falls and identifying medications as risk factors for falls can lead to intervention and prevention of falls. 2) They asked if people had complaints caused by their drugs. A correct opinion was found in 79% of respondents who answered “yes”, meaning a non-severe ADE was confirmed when people thought a medication was causing a problem 79% of the time. This means that people are fairly astute at recognizing non-severe ADEs from any of their medications. However, 72% were not able to sense they were experiencing a severe ADE such as gastrointestinal bleeding.
When you suspect a medication may be causing a problem, don’t let it go but persist in finding out what’s going on. There is a strong likelihood that you are experiencing an ADE that can impact your function and quality of life. When looking at falls and ADEs, there are a number of strategies that can be employed to help reduce your risk of a fall, one being reducing medication use altogether, lowering doses of blood pressure medications when you experience dizziness, staying away from drugs that are strongly associated with falls such as benzodiazepines, which are drugs like Valium (diazepam), Ativan (lorazepam), Xanax (alprazolam), and other drugs even as apparently innocuous such as Tylenol PM (acetaminophen & diphenhydramine) and Benadryl (diphenhydramine). Even these over-the-counter (OTC) medications are known to contribute to falls. There is more to know about the relationship between falls and medications and this is only an introduction to set you in the right direction. Keep in mind that any changes in your medication regimen should be done only under the supervision of an experienced medical professional who is well versed in this area. That’s it for now, stay well and stay upright!
| Print article | This entry was posted by Alan Lukazewski on February 3, 2011 at 8:42 pm, and is filed under Adverse Drug Events, Falls, Syndromes. Follow any responses to this post through RSS 2.0. You can leave a response or trackback from your own site. |




about 1 year ago
Just went to a CE class: medical emergencies. Didn’t know acetaminophen is actually a toxic substance that is used because of it’s analgesic properties (?) Compounding acetaminophen from various sources, i.e. liquid cold med., aceta.tablets for headache etc…..can lead to death as it’s easy to O.D. if you don’t keep track of the amount you’re ingesting. I won’t be using acetaminophen anymore, but the is it correct that the RDD is below 4000mg?
about 1 year ago
The total maximum daily dose for acetaminophen, or Tylenol, is 4gm for most people. However, in older adults there is some suggestion that 3gm is safer. If one already has kidney or liver damage then you should consult your physician as it is most likely contraindicated in those circumstances. Otherwise, acetaminophen is a safe and well tolerated analgesic which remains the initial drug of choice for osteoarthritic pain in older adults. However, in order to not cause kidney or liver damage, one must count all the acetaminophen one might be taking that is not obviously labeled in some combination cough and cold products, or other products such as Tylenol PM.