Abstract
Introduction: Elderly patients in nursing homes (EHPAD) are often afflicted by multiple disorders and exposed to numerous medications. The number of drugs prescribed is correlated with an increased risk of adverse drug reactions (ADRs), often the cause of hospitalizations.Material and methods: We retrospectively identified all EHPAD residents admitted to the Montpellier University Hospital emergency department (ED) during the year 2019. Among them, we selected the patients who were eventually hospitalized. For each patient, drugs exposure was then analysed to appreciate the presence of potential iatrogenic risks classified into 12 categories (e.g. haemorrhagic, sedative, convulsive, hypotensive, cardiac, respiratory, digestive, glycaemic, electrolytic, renal, pancreatic) using the Warnings and Precautions section of the drugs Summary of Product Characteristics as reference. These predictive risks were subsequently compared with the ADRs presented by the hospitalized patient.Results: A total of 978 visits to the ED involving 670 patients were identified. Of these, 40.1% (n = 263) required hospitalization. Most patients were female (65.8%) with a mean age of 87.1 years. 52.1% (n = 137) had at least three comorbidities. The complete drug regimen was found for 98.5% (n = 259) and 85.6% (n = 219) had over 5 and up to 22 medications. A total of 55 ADRs occurring in 46 (17.8%) patients were identified: 34.5% (n = 19) in the ED, 47.3% (n = 26) during hospitalization, and 18.2% (n = 10) were identified retrospectively by the CRPV during this retrospective study. Remarkably, the comparison between the predictive risks and the ADRs actually observed indicates that 44 (80.0%) of them were predictable.Discussion/Conclusion: As expected, drug-related iatrogeny is very marked in the elderly, especially in the EHPAD population. The analysis of the predictability of ADRs, indicates that a large part of them could be avoided. Preventive actions targeted on high-risk drug classes could decrease this iatrogenic risk and promote a better adequate use in this population.