Geriatric Conditions, Medication Use, and Risk of Adverse Drug Events in a Predominantly Male, Older Veteran Population

Authors

  • Michael A. Steinman MD,

    1. From the *San Francisco Veterans Affairs Medical Center, San Francisco, California; Division of Geriatrics and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California; Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa; and §Department of Epidemiology, College of Public Health and #Division of General Internal Medicine, Department of Internal Medicine, University of Iowa, Iowa City, Iowa.
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  • Brian C. Lund PharmD,

    1. From the *San Francisco Veterans Affairs Medical Center, San Francisco, California; Division of Geriatrics and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California; Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa; and §Department of Epidemiology, College of Public Health and #Division of General Internal Medicine, Department of Internal Medicine, University of Iowa, Iowa City, Iowa.
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  • Yinghui Miao MPH,

    1. From the *San Francisco Veterans Affairs Medical Center, San Francisco, California; Division of Geriatrics and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California; Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa; and §Department of Epidemiology, College of Public Health and #Division of General Internal Medicine, Department of Internal Medicine, University of Iowa, Iowa City, Iowa.
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  • W. John Boscardin PhD,

    1. From the *San Francisco Veterans Affairs Medical Center, San Francisco, California; Division of Geriatrics and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California; Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa; and §Department of Epidemiology, College of Public Health and #Division of General Internal Medicine, Department of Internal Medicine, University of Iowa, Iowa City, Iowa.
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  • Peter J. Kaboli MD

    1. From the *San Francisco Veterans Affairs Medical Center, San Francisco, California; Division of Geriatrics and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California; Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa; and §Department of Epidemiology, College of Public Health and #Division of General Internal Medicine, Department of Internal Medicine, University of Iowa, Iowa City, Iowa.
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  • This work was presented at the annual meeting of the American Geriatrics Society, Orlando, Florida, May 2010.

Address correspondence to Michael Steinman, 4150 Clement St, Box 181G, San Francisco VA Medical Center, San Francisco, CA 94121. E-mail: mike.steinman@ucsf.edu

Abstract

OBJECTIVES: To determine whether geriatric conditions and functional impairment are independent risk factors for adverse drug events (ADEs).

DESIGN: Prospective cohort study.

SETTING: Veterans Affairs Medical Center.

PARTICIPANTS: Three hundred seventy-seven veterans aged 65 and older and taking five or more medications.

MEASUREMENTS: Geriatric conditions and functional status were assessed using participant interviews and structured assessments at study baseline. ADEs were elicited during participant interviews 3 and 12 months after study enrollment using validated methods.

RESULTS: The strong majority (97%) of participants were male, with a mean age of 74±5; 123 (33%) had one or more dependencies in instrumental activities of daily living (IADLs). Over the 1-year study period, 126 participants (33%) developed 167 ADEs. Upon multivariable analysis, risk of ADEs was not associated with any of the geriatric conditions that there was sufficient power to evaluate, including IADL function, cognitive impairment, depression, visual impairment, incontinence, constipation, and a summative measure of geriatric burden comprising the above and history of falls or gait instability. In exploratory analyses, the strongest factor associated with ADEs was the number of drugs added to a participant's medication regimen during the 1-year study period (incidence rate ratio 1.11 per each added drug, 95% confidence interval=1.03–1.19).

CONCLUSION: Common geriatric conditions and IADL function were not associated with ADEs in a predominantly male, older veteran population. Although it is important to consider the unique circumstances of each participant, excessive caution in prescribing to older adults with these geriatric conditions may not be warranted.

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