Yadesa Tadele Mekuriya, Kitutu Freddy Eric, Deyno Serawit, Ogwang Patrick Engeu, Tamukong Robert, Alele Paul E
PHARMBIOTRAC, World Bank's ACE-II Project, Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
Department of Pharmacy, College of Medicine & Health Sciences, Ambo University, Ambo, Ethiopia.
SAGE Open Med. 2021 Aug 18;9:20503121211039099. doi: 10.1177/20503121211039099. eCollection 2021.
Occurrence of adverse drug reactions is a major global health problem mostly affecting older adults. Identifying the magnitude and predictors of adverse drug reactions is crucial to developing strategies to mitigate the burden of adverse drug reactions. This study's objectives were to estimate and compare the prevalences of adverse drug reactions, to characterize them and to identify the predictors among hospitalized older adults.
A comprehensive systematic literature search including both prevalence and risk factors of adverse drug reactions in hospitalized older adults was conducted using PubMed, Scopus and Google Scholar, involving all articles published in English. Descriptive statistics and comparison of means was performed using SPSS version 20.0 and metaprop command was performed in STATA version 13.0. Heterogeneity was assessed using statistic.
A total of 18 studies, involving 80,695 participants with a median age of 77 years, were included in this study. The pooled prevalence of adverse drug reaction was 22% (95% confidence interval: 17%, 28%; = 99.23%). Among high-income countries, the prevalence of adverse drug reactions was 29% (95% confidence interval: 16%, 42%) as compared to 19% (95% confidence interval: 14%-25%) in low and middle-income countries ( value = 0.176). Of the 620 adverse drug reactions categorized, most were type A (89%), which are generally predictable and preventable. Two-thirds (795, 67%) of the adverse drug reactions were probable and most (1194, 69%) were mild or moderate. The majority (60%) of the categorized adverse drug reactions were preventable and less than one-third (31%) were severe. The most consistently reported predictors of adverse drug reactions in hospitalized older patients were medication-related factors, including polypharmacy and potentially inappropriate medications followed by disease-related factors-renal failure, complex comorbidity, heart failure and liver failure.
Almost one-quarter of all hospitalized older adults experienced at least one adverse drug reaction during their hospital stay. The majority of the adverse drug reactions were preventable. Medication-related factors were the most consistently reported predictors of adverse drug reactions followed by disease-related factors.
药物不良反应的发生是一个主要的全球健康问题，对老年人影响尤甚。确定药物不良反应的严重程度和预测因素对于制定减轻药物不良反应负担的策略至关重要。本研究的目的是估计和比较住院老年人中药物不良反应的患病率，对其进行特征描述并确定预测因素。
使用PubMed、Scopus和谷歌学术对住院老年人药物不良反应的患病率和风险因素进行全面系统的文献检索，纳入所有英文发表的文章。使用SPSS 20.0进行描述性统计和均值比较，并在STATA 13.0中执行metaprop命令。使用 统计量评估异质性。
本研究共纳入18项研究，涉及80695名参与者，中位年龄为77岁。药物不良反应的合并患病率为22%（95%置信区间：17%，28%； = 99.23%）。在高收入国家，药物不良反应的患病率为29%（95%置信区间：16%，42%），而在低收入和中等收入国家为19%（95%置信区间：14% - 25%）（ 值 = 0.176）。在分类的620例药物不良反应中，大多数为A型（89%），通常是可预测和可预防的。三分之二（795例，67%）的药物不良反应可能发生，且大多数（1194例，69%）为轻度或中度。分类的药物不良反应中大多数（60%）是可预防的，不到三分之一（31%）为严重不良反应。住院老年患者中最一致报告的药物不良反应预测因素是与药物相关的因素，包括多药合用和潜在不适当用药，其次是与疾病相关的因素——肾衰竭、复杂合并症、心力衰竭和肝功能衰竭。
几乎四分之一的住院老年人在住院期间至少经历过一次药物不良反应。大多数药物不良反应是可预防的。与药物相关的因素是最一致报告的药物不良反应预测因素，其次是与疾病相关的因素。
