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Adverse Drug Reactions as Cause of Hospital Admissions: Results from the Italian Group of Pharmacoepidemiology in the Elderly (GIFA)

Authors

  • Graziano Onder MD,

    1. Section of Gerontology and Geriatrics, Sticht Center on Aging, Wake Forest University—Baptist Medical Center, Winston Salem, North Carolina;
    2. Centro Medicina Invecchiamento, Institute of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy; and
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  • Claudio Pedone MD, PHD, MPH,

    1. Centro Medicina Invecchiamento, Institute of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy; and
    2. Center for Gerontology and Health Care Research, Brown University Medical School, Providence, Rhode Island.
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  • Francesco Landi MD, PHD,

    1. Centro Medicina Invecchiamento, Institute of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy; and
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  • Matteo Cesari MD,

    1. Centro Medicina Invecchiamento, Institute of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy; and
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  • Cecilia Della Vedova MD,

    1. Centro Medicina Invecchiamento, Institute of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy; and
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  • Roberto Bernabei MD,

    1. Centro Medicina Invecchiamento, Institute of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy; and
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  • Giovanni Gambassi MD

    1. Centro Medicina Invecchiamento, Institute of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy; and
    2. Center for Gerontology and Health Care Research, Brown University Medical School, Providence, Rhode Island.
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Address correspondence to Graziano Onder, MD, Istituto di Geriatria, Centro Medicina dell'Invecchiamento—CEMI, Universita Cattolica del Sacro Cuore, Policlinico A. Gemelli, L.go F. Vito 1, 00168 Roma, Italy. E-mail: graziano_onder@rm.unicatt.it

Abstract

OBJECTIVES: To determine the prevalence of adverse drug reaction (ADR)-related hospital admissions in an older population, to describe the most common clinical manifestations and drugs most frequently responsible for ADR-related hospital admissions, and to identify independent factors predictive of these ADRs.

DESIGN: Multicenter pharmacoepidemiology survey conducted between 1988 and 1997.

SETTING: Eighty-one academic hospitals throughout Italy.

PARTICIPANTS: Twenty-eight thousand four hundred eleven patients consecutively admitted to participating centers during the survey periods.

MEASUREMENTS: For each suspected ADR at admission, a physician, who coded description, severity, and potentially responsible drugs, completed a questionnaire.

RESULTS: Mean age ± standard deviation of the patients was 70 ± 16. One thousand seven hundred four ADRs were identified upon hospital admission. In 964 cases (3.4% of all admissions), ADRs were considered to be the cause of these hospital admissions. Of these, 187 ADRs were coded as severe. Gastrointestinal complaints (19%) represented the most common events, followed by metabolic and hemorrhagic complications (9%). The drugs most frequently responsible for these ADRs were diuretics, calcium channel blockers, nonsteroidal antiinflammatory drugs, and digoxin. Female sex (odds ratio (OR) = 1.30, 95% confidence interval (CI) = 1.10–1.54), alcohol use (OR = 1.39, 95% CI = 1.20–1.60), and number of drugs (OR = 1.24, 95% CI = 1.20–1.27 for each drug increase) were independent predictors of ADR-related hospital admissions. For severe ADRs, age (OR = 1.50, 95% CI = 1.01–2.23 for age 65–79 and OR = 1.53, 95% CI = 1.00–2.33 for age ≥80, respectively), comorbidity (OR = 1.12, 95% CI = 1.05–1.20 for each point in the Charlson Comorbidity Index), and number of drugs (OR = 1.18, 95% CI = 1.11–1.25 for each drug increase) were the only predisposing factors.

CONCLUSIONS: The most important determinant of risk for ADR-related hospital admissions in older patients is number of drugs being taken. When considering only severe ADRs, risk is also related to age and frailty.

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