Study Suggests Excessive Caution in Prescribing to Veterans with Geriatric Conditions May Be Unnecessary
Clinicians may use extra caution when prescribing drugs to older adults who suffer from common geriatric conditions (e.g., frailty, functional impairment), based on the assumption that they are at greater risk of suffering adverse drug events (ADEs) and other problems associated with medication use. This prospective cohort study evaluated whether common geriatric conditions were associated with risk of ADEs. Using data from the Enhanced Pharmacy Outpatient Clinic study, investigators identified 377 Veterans from one VAMC, age 65 years or older, who were taking five or more medications, and assessed geriatric conditions and functional status. ADEs were evaluated during patient interviews at 3 and 12 months after study enrollment. Potential predictors of ADEs were assessed in six domains: demographics, medication use, self-rated health, function, geriatric conditions (e.g., cognitive impairment, depression, impaired gait), and other comorbid conditions.
Findings show that over the one-year study period, 126 Veterans suffered a total of 167 ADEs, but there was no association between the presence of various geriatric conditions and ADEs. However, in exploratory analyses investigators found that the use of new medications (present at 12-month follow-up) was associated with a higher risk of ADEs. Results also showed that the median number of medications used at baseline was 12, and that at one-year follow-up Veterans were taking a median of two new drugs. Also, one-third of Veterans had some impairment in instrumental activities of daily living, and 43% had one or more geriatric conditions; the most common were cognitive impairment (15%), depression (14%), and visual impairment (12%).
The authors suggest that while it is important to consider the unique circumstances of each patient, excessive caution in prescribing to elders with geriatric conditions may not be warranted.
Steinman M, Lund B, Miao Y, Boscardin W, and Kaboli P. Geriatric conditions, medication use, and risk of adverse drug events in a predominantly male, older Veteran population. Journal of the American Geriatrics Society April 2011;59(4):615-621.
This study was partly funded by HSR&D (SAF 98-152); Dr. Kaboli was supported by an HSR&D Career Development Award. Dr. Steinman is part of HSR&D's Program to Improve Care for Veterans with Complex Comorbid Conditions in San Francisco. Drs. Lund and Kaboli are part of HSR&D's Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City, IA.