4069 — Adverse Drug Events in the Veterans Healthcare System: Reported Incidence, Severity and Causative Medications by Age Range

Lead/Presenter: Peter Glassman, COIN - Los Angeles
All Authors: Glassman P (Department of Medicine, VA Greater Los Angeles Healthcare System) Moore V (VA Center for Medication Safety, VA Pharmacy Benefits Management Services) Au A (VA Center for Medication Safety, VA Pharmacy Benefits Management Services) Good C (Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System ) Cunningham F (VA Center for Medication Safety, VA Pharmacy Benefits Management Services)

Objectives:
Adverse drug events are often considered to be associated with age, with older patients having more events. We sought to explore the incidence and severity of reported adverse drug events across age ranges, and to explore common causative medications in different age ranges.

Methods:
The VA Adverse Drug Event Reporting System (VA ADERS) was used to assess 10-year age range groups in terms of reporting rates, severity and causative agents. Data was derived from 484,351 VA ADERS reports from 2009 to 2016.

Results:
Reported rates of adverse drug events (ADEs) per 10,000 unique users appear to have a non-linear relationship with age. Specifically, the 20-29 age group had 69 reports/10,000 unique users, and ADEs peaked in the age group ranges of 50-59 (139 reports/10,000 unique users) and 60-69 (148 reports/10,000 unique users) and then decreased in older age groups (e.g., 70-79 and 80-89 at 131 and 108 reports/10,000 unique users respectively) apart from those 100 years old and older which rose somewhat. However, the percentage of adverse drug events reported as severe consistently rose with age group (3% in 20-29 year olds increasing to 6% in 90-99 year olds). Common medications as causative agents shifted over time from predominantly mental health and pain medications in younger veterans (e.g., 20-29 year olds) to predominantly chronic disease state medications in older cohorts.

Implications:
Our data suggest a higher incidence of adverse drug events in age ranges 50 to 59 and 60 to 69 with relatively lower incidences in subsequent age groups. However, severity increased by age group. Common drugs reported as causing ADEs shift with age from those more focused on mental health and pain to those addressing other chronic disease states

Impacts:
VA data suggests that while there may be fewer ADEs in older age groups relatively to those 50 to 69, these may be associated more frequently with serious health consequences. These findings may have implications for clinicians, especially when caring for older patients.