Older, poorer people at greater risk from adverse drug reactions

A review by Swansea University academics has found that older, poorer people, who are socially distanced from their doctors or pharmacists, suffer more adverse drug reactions (ADRs) than the general population and that systematic monitoring is needed to protect these patients suffering from reactions which could result in over-sedation, falls, or drug induced Parkinsonism.

The paper, published in Geriatrics, acknowledges that despite modern efforts to move towards patient centred medicine, doctors tend to treat their patients at a distance. The emphasis on prescribing treatment for patients, while having limited contact with them, is especially true in relation the treatment of older patients in long-term care facilities. The problem is amplified by the overall lack of regular systematic reviews of the patient, meaning opportunities are being missed to identify medication errors and undetected ADRs.

Swansea University reports Professor David Hughes, who led the paper, said “It is very unfortunate that the combination of social distance between doctors and older and often poorer patients, and treatment centring on drugs prescribed without regular patient contact and checks, increases the risks of medication mistakes and ADRs. I am also very concerned that is a much more common scenario during the pandemic, given that patients in care homes are more likely to be living in lockdown, often without direct contact with their doctors.”

The study recommends the use of the Adverse Drug Reaction Profile (ADRe) as a solution. The Adverse Drug Reaction Profile is a carer administered systematic checklist that makes the detection of common ADRs easier and provides staff and nurses with information to link signs and symptoms on the checklist to prescription medicines. This multi-disciplinary approach allows home care staff and nurses to link in with prescribers such as doctors and pharmacists, to provide them with personalised patient information and evidence so that prescribers are able to respond quickly to identified problems and adjust prescribing.

Paper co-author Professor Sue Jordan said “The profile identifies and documents patients’ signs and symptoms of ADRs and better monitoring allows professionals to respond with agility. While we realise that the implementation of the ADRs monitoring system will require changes to the regulatory regime at inspectorate level, it will make for better inter-professional cooperation. Providing carers, nurses and pharmacists with a structured system to monitor patients would democratise relevant medical knowledge and also help address ageism and the socio-economic health divide.”

Visit the ADRe project website.

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