PROBABLE ADVERSE DRUG-REACTIONS IN A RURAL GERIATRIC NURSING-HOME POPULATION - A 4-YEAR STUDY

OBJECTIVE: To quantitate probable adverse drug reactions (ADRs) in a g eriatric nursing homes population. DESIGN: A repeated measures prospec tive study. SETTING: Two nursing home populations in rural Georgia. PA TIENTS: All 332 residents present for 30 or more days over a 4-year pe riod. MEASUREMENT: Admission and monthly drug regimen review for each resident, Naranjo algorithm assessment of each ADR, with monthly repor ts to attending physicians and follow-up within the next month. RESULT S: There were 444 probable ADRs in 217 of 332 residents (67.4%) during this period. The 217 residents had a mean 1.9 +/- 1.3 probable advers e drug reactions (range, 1-9). The ADR group differed statistically fr om the rest of the population only in the number of drugs per patient (7.8 +/- 2.6 vs 3.3 +/- 1.3), which was almost twice the number of act ive problems present in both the ADR (4.0 +/- 0.9) and non-ADR populat ions (3.8 +/- 1.4). The organ systems most commonly involved in the 44 4 ADRs observed were cardiovascular (188), central nervous system (129 ), gastrointestinal (82), endocrine (41), immune (17), hematologic (7) , pulmonary (6), and renal (5). The drugs most commonly implicated in ADRs were, in decreasing order, diuretics, antipsychotics, anxiolytics , potassium supplements, digoxin, NSAIDs, insulin, theophylline, Hz-re ceptor antagonists, antiinfectives, anticonvulsants, and thyroid suppl ements. There were 39 multiple drug ADRs in 34 patients. In decreasing order the drug classes in multiple ADRs were CNS depressants, antihyp ertensives, potassium-altering therapy, and NSAIDs. Numerous patients had repetitions of the same ADR, especially with antipsychotics, NSAID s, and insulin. CONCLUSIONS: ADRs are a common occurrence in a geriatr ic nursing home population, and may be related to inadequate attention to the patients history as well as to unrealistic therapeutic endpoin ts.