Departamento de Ciencias y Tecnología Farmacéutica, Farmacia Clínica, Facultad de Ciencias Químicas y Farmacéuticas, Universidad de Chile, Olivos 1007, Room 210, Independencia, 8380492, Santiago, Chile.
Service of Internal Medicine, Clinical Hospital at the University of Chile, Santiago, Chile.
Int J Clin Pharm. 2021 Aug;43(4):839-846. doi: 10.1007/s11096-020-01181-3. Epub 2020 Nov 17.
Background Acutely ill older persons are more likely to suffer adverse drug reactions, increasing morbidity, and mortality. The incident adverse drug reactions and their consequences on the length of hospital stay (LOS) in older persons have been little explored. Objective To determine the incident adverse drug reactions in acutely ill older inpatients and their effect on the LOS. Setting Internal medicine service in a Chilean teaching hospital. Method A prospective cohort study was conducted in patients aged ≥ 60 years admitted into the internal medicine service of the Hospital from University of Chile. Characteristics, severity, and causality of adverse drug reactions were assessed. Effect of incident adverse drug reactions on the LOS was determined using multiple Cox regression. A secondary analysis was conducted in patients aged ≥ 65 years. Main outcome measure Incident adverse drug reactions (new events occurring in hospital) and their effect on the LOS in older inpatients. Results A total of 229 acutely ill older persons ≥ 60 years were followed-up. Fifty-six of them suffered 77 adverse drug reactions (incident rate 24.5%; 95% CI: 19.0, 30.5), 70.1% type A. Adverse drug reactions were severe in 5.4% of cases. Causality assessment indicated the majority were probable (57.1%) and 3.9% certain. Cardiovascular agents were the therapeutic class more frequently involved. The most frequent adverse drug reaction was hypotension (19.5%). Patients with adverse drug reactions had a significantly prolonged LOS than those without adverse drug reactions (12.4 ± 11.0 versus 7.3 ± 6.4 days; p < 0.0001) (adjusted Hazard Ratio 0.63; 95% CI: 0.46, 0.87; p < 0.01), respectively. The incidence rate of adverse drug reactions in patients ≥ 65 years was 25.1% (95% CI: 19.0; 32.1), and their occurrence was significantly associated with a prolonged LOS (p < 0.05). Conclusion One in four acutely ill older persons hospitalized in the internal medicine service suffered at least one incident adverse drug reaction, which prolonged the LOS by 5 days. There is a potential to optimize the use of hospital beds and medication safety by preventing adverse drug reactions in geriatric patients.
患有急性病的老年人更容易发生药物不良反应，增加发病率和死亡率。老年人中药物不良反应的发生率及其对住院时间（LOS）的影响尚未得到充分探讨。目的：确定急性病老年人中的药物不良反应事件，并评估其对 LOS 的影响。地点：智利一所教学医院的内科。方法：对来自智利大学附属医院内科的 60 岁以上住院患者进行前瞻性队列研究。评估药物不良反应的特征、严重程度和因果关系。采用多 Cox 回归确定药物不良反应事件对 LOS 的影响。对 65 岁以上患者进行了二次分析。主要结局指标：老年人中药物不良反应事件（住院期间新发生的事件）及其对 LOS 的影响。结果：共随访 229 名 60 岁以上急性病老年人。其中 56 人发生 77 次药物不良反应（发生率 24.5%；95%CI：19.0，30.5），70.1%为 A 型。5.4%的药物不良反应为严重程度。因果关系评估表明，大多数为可能（57.1%）和确定（3.9%）。心血管药物是最常涉及的治疗类别。最常见的药物不良反应是低血压（19.5%）。发生药物不良反应的患者与未发生药物不良反应的患者相比， LOS 显著延长（12.4±11.0 天与 7.3±6.4 天；p<0.0001）（调整后的 HR 0.63；95%CI：0.46，0.87；p<0.01）。65 岁以上患者的药物不良反应发生率为 25.1%（95%CI：19.0；32.1），其发生与 LOS 延长显著相关（p<0.05）。结论：内科住院的四分之一急性病老年人至少发生一次药物不良反应事件，使 LOS 延长 5 天。通过预防老年患者的药物不良反应，可以优化病床利用和药物安全。
