There are several published articles that have caught my attention that focus on perceived and self-reported adverse events in the patient population. One article, Adverse Drug Reactions in Elderly Patients as Contributing Factor for Hospital Admission: cross sectional study, Mannesse, C., et al, BMJ Vol 315, Oct. 1997. They reported that people were reliable in detecting adverse drug events in themselves, with a correct opinion in 73 out of 93 who answered the question whether they were experiencing an adverse drug event (ADE). However, these were adverse events that were less severe, and the more serious adverse events that caused hospitalization, such as gastrointestinal bleeding, were not well detected. In another study, Patient-reported Medication Symptoms in Primary Care, Weingart, S, MD, et al, ArchIntMed, Vol 165, Jan. 24, 2005, the authors measured how many people thought they were experiencing an adverse event (179 people & 286 events) and what percentage reported them to their physicians, along with what percentage were acted upon by their physicians. Only 69% were reported to their physicians, and only 76% were acted upon. The authors estimated that a failure to report symptoms led to 19 (21%) ameliorable ADEs, and 2(2%) preventable. A failure to change therapy in 48 cases led to 31 (65%) ADEs that authors estimated to be ameliorable. The conclusion is that people are fairly good at knowing when they are experiencing and ADE, a lesson I learned early on in working with older adults in a retirement community, where an older adult convinced me he was experiencing memory loss from one of his medications, but I didn’t believe him at first. So if we listen and believe, kind of like having faith, we should be able to detect an ADE before it affects the function of the older adult. We just need to ask the question.
In a study in progress, we performed comprehensive medication reviews (CMRs) in 69 older adults and within the CMR questionnaire we asked the two questions, 1) What history do you have of adverse drug events (medication side-effects)?, and 2) Do you think you are experiencing an adverse drug event right now? Of the 69 participants, 28 answered both questions positive, yet only 4 said they were having an ADE but had a negative history of an ADE. When applying a 2×2 contingency table with Fischer’s test for exactness, we found a p-value of 0.00001 meaning the correlation was highly significant. That is to say, people were far more likely to say they are experiencing an ADE if they had a history of an ADE, as opposed to those without a history. This aligns with another article titled Adverse Drug Reaction Risk factors in Older Populations, Hajjar, E., Hanlon, JT, et al, AmJGerPharm., Dec. 2003 Vol. 1 (2) 82-89. Risk factors for ADEs were developed by a panel of experts in ADEs and one risk factor identified and agreed upon by the experts was a history of an ADE.
So it stands that it might be wise to put in your office visit routine the questions of “What history of adverse effects do you have from medications?” and “Do you think you are experiencing an adverse effect right now?”, and then listen and act. You might positively affect the life of an older adult by keeping them more functional and/or out of the hospital.