Inappropriate Medication Use and Medication Errors in the Elderly
Medications are commonly used by older adults. While medications can relieve symptoms and prevent further disease complications, they unfortunately can also cause adverse drug events (ADEs). An ADE can be defined as “an injury resulting from the use of a
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Introduction Medications are commonly used by older adults. While medications can relieve symptoms and prevent further disease complications, they unfortunately can also cause adverse drug events (ADEs). An ADE can be defined as “an injury resulting from the use of a drug” (Aspden et al. 2007; Nebeker et al. 2004). The right side of Fig. 1 shows the three types of ADEs: (1) adverse drug reactions (ADRs) (i.e., a response to a drug that is noxious and unintended and occurs at doses normally used for the prophylaxis, diagnosis, or therapy of disease or for modification of physiological function); (2) therapeutic failures (TFs) (i. e., failure to accomplish the goals of treatment resulting from inadequate drug therapy and not related to the natural progression of disease); and (3) adverse drug withdrawal reactions (ADWEs) (i.e., a clinical set of symptoms or signs that are related to the removal of a drug) (Edwards and Aronson 2000; Hanlon et al. 2010). Besides death, which fortunately is rarely due to medications, one of the worst consequences of medication use in older adults is hospitalization. Studies have shown that up to 16% of hospital admissions are due to ADRs, up to 11% due to TFs, and
Z.A. Marcum and J.T. Hanlon (*) University of Pittsburgh, Division of Geriatric Medicine Pittsburgh, PA, 3471 Fifth Ave. Kaufmann Building, Suite 500, Pittsburgh, PA 15213, USA e-mail: [email protected]
approximately 1% due to ADWEs (Beijer and de Blaey 2002; Kaiser et al. 2006; Marcum et al. 2011). Taken together, these medication-related problems are a significant cause of morbidity and mortality as well as unnecessary healthcare costs in older adults. While some ADEs are unavoidable (e.g., leukopenia from chemotherapy or allergic reaction to penicillin), many may be preventable because they are due to medication errors. A medication error is a mishap that occurs during the prescribing, order communication, dispensing, administering, adherence, or monitoring of a drug (Aspden et al. 2007; Nebeker et al. 2004; Lisby et al. 2010; National Coordinating Council for Medication Error Reporting and Prevention 1998). The relationship between medication errors and ADEs is shown in Fig. 1. For more information about potential monitoring errors in older adults, refer to a recent comprehensive review (Steinman et al. 2011). Moreover, there is limited information about pharmacy dispensing errors that is specific to older adults; therefore, the topic is not further discussed in this chapter (Flynn et al. 2009). In addition, chapter “Adherence to Pharmacotherapy in the Elderly” in this book covers the topic of medication adherence in older patients. Thus, this chapter focuses on specific aspects of suboptimal prescribing and medication administration errors.
M. Wehling (ed.), Drug Therapy for the Elderly, DOI 10.1007/978-3-7091-0912-0_5, # Springer-Verlag Wien 2013
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Z.A. Marcum and J.T. Hanlon
Medication Use Process Prescribing
Adverse Drug Reactions
Order communication
Dispensing Therapeutic Failures Administering/ Adherence
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