PHARMACOVIGILANCE STUDY IN GERIATRIC POPULATION
Abstract
Objective: Pharmacovigilance is defined as the science and activities concerned with the detection, assessment, understanding and prevention
of adverse reactions to medicines. Main goal of pharmacovigilance in geriatric is to improve the safe and rational use of medicines and thereby
improving patient care, health of the society. Pharmacovigilance is particularly concerned with the adverse drug reactions (ADR's). Hence, a closer
pharmacovigilance studies are much needed in the older age group due to polypharmacy, which can cause ADR's leading to hospital readmission
and the direct and indirect treatment cost to treat the ADR's. The objective of this study was to assess the prescribing practice and ADR's in
geriatric patients with two or more comorbid condition during the stay in the hospital and to follow-up on 15th, 30th, 45th, 60th, 75th and 90th day
after discharge.
Methods: The study was conducted in Medicine Department, Kempegowda Institute of Medical Science Hospital and Research Centre, Bengaluru. It is
a non-randomized observational prospective study conducted for a period of 6 months, to assess the prescribing pattern and incidence of ADR in the
geriatric population. We made an attempt to assess the incidence of ADRs after discharge from the hospital by doing follow-ups.
Results: Among the 50 patients included during the study, 29 (58%) patients were between the age group of 60 and 65 years, out of which 20 were
female, and 9 were found to be male patients. Out of 50 patients, 40 (37.7%) patients suffered from hypertension, 30 (28.3%) patients had diabetes
mellitus. The most commonly used antihypertensive drug was found that 20 (33.8%) patients were on calcium channel blockers which were used
majorly, in anti-diabetic drugs, insulin was used in 19 (44.1%) patients, followed by 10 (23.2%) patients who were prescribed oral hypoglycemic
like metformin. Number of drugs prescribed per prescription was found that 68% of patients were prescribed with 6-10 drugs. Among the study
population, we found the incidence of three mild ADRs during follow-up. During analyzing of prescription, we found totally 122 drug interactions, out
of which 83 (68%) were moderate, 30 (25%) were mild and 9 (7%) were found to be severe drug interactions.
Conclusion: We observed that monitoring of drugs for ADRs in the geriatric population is mandatory due to their polypharmacy. Follow-up studies
after discharge for monitoring of ADR will be one step ahead to improve the quality of life. This can reduce the hospital readmission, which can in turn
reduce to the economic burden of the patients.
Keywords: Pharmacovigilance, Adverse drug reactions, Geriatric, Polypharmacy.
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References
World Health organization [homepage on the Internet], Switzerland. [Cited 2013 December 24] Available from: http://www.who.int/medicines/areas/quality_safety/safety_efficacy/pharmvigi/en/.
World Health organization [homepage on the Internet], Switzerland. [cited 2013 December 24] Available from: http://www.who.int/healthinfo/survey/ageingdefnolder/en/.
H Singh, N Dulhani, BN Kumar et al. A Pharmacovigilance study in medicine department of tertiary care hospital in Chattisgarh, India. Journal of young pharmacists. Jan-Mar 2010; 2(1):95-100.
P A Routledge, M S O'Mahony, and K W Woodhouse. Adverse drug reaction in elderly patients.Br J Clin Pharmacol 2004 February; 57(2):121-126.
Marie N. O’Connor, Paul Gallagher, Stephen Byrne et.al. Adverse drug reaction in older patients during hospitalization: are they predictable? Age and Ageing 2012; 41:771-776.
Shalini, MC Joshi. Study of polypharmacy and associated problems among elderly patients. Internet journal of medical update 2012; 7(1):35-39.
Jimmy Jose, promoting drug safety in elderly- needs a proactive approach. Indian Journal of Medical Research September 2012; 136(3):362-364.
Jones Grizzle A. J and Draugalis J. R. Demographics, In Geriatric Pharmacology. Edited by R. Bressler and M. D. Katz. New York: McGraw-Hill. 1993; 1-8.
Harugeri A, Parthasarathi G, Ramesh M et al. Frequency and nature of adverse drug reactions in elderly in-patients of two Indian medical college hospitals. Journal of postgraduate medicine 2011; 57(3): 189-195.
Ayesha Romana, Laxminarayana Kamath, Astha Sarda et.al. Polypharmacy leading to adverse drug reactions in elderly in a tertiary care hospital. International journal of pharma biosciences 2012; 3(3):218-224.
Charnelda L. Gray and Carole Gardner. Adverse drug events in the elderly: an ongoing problem. Journal of Managed Care Pharmacy Sep 2009; 15(7):568-571.
Abdulraheem IS. Polypharmacy: a risk factor for geriatric syndrome, morbidity and mortality. Journal of Aging science 2013; 1(2).
Emma C Davies, Christopher F Green, David R Mottram et.al. Emergency readmissions to hospital due to adverse drug reactions within 1 year of the index admission, Br J Clin Pharmacol Nov 2010; 70(5):749-755.
Anita Conforti, Davide Costantini, Francesca Zanetti et.al. Adverse drug reactions in older patients: an Italian observational prospective hospital study. Drug, Healthcare and Patient Safety July 2012; 4: 75-80.
Marie-Laure Laroche, Jean-Pierre Charmes, Yves Nouaille et.al. Is inappropriate medication use a major cause of adverse drug reactions in the elderly? Br J Clin Pharmacol Feb 2007; 63(2):177-186.
Arshad H. Mohd, Uday V. Mateti, Venkateswarlu Konuru et al. A study on prescribing patterns of antihypertensives in geriatric patients. Perspectives in clinical research Oct-Dec 2012; 3(4):139-142.
Mark Monane, Dipika M. Matthias, Becky A. Nagle et al. Improving prescribing patterns for the elderly through an online Drug Utilization Review intervention. JAMA. Oct 1998; 280(14):1249-1252.
Michael A. Steinman, C. Seth Landefeld, Gary E. Rosenthal et al. polypharmacy and prescribing quality in older people. J Am Geriatric Soc 2006 Oct; 54(10):1516-23.
Louis Meale, Marie-Laure Laroche, Thierry Dantoine et al. Predicting and preventing Adverse drug reactions in the very old. Drugs and Aging May 2005; 22(5): 375-392.
Klaas A. Hartholt, Nathalie van der Velde, Caspar W. N. Looman et.al. Adverse drug reactions related hospital admissions in persons aged 60 years and over, The Netherlands, 1981-2007: less rapid increase, different drugs. PLOS ONE November 2010; 5(11).
H.J.M. Beijer, C.J. de Blaey. Hospitalization caused by adverse drug reaction: a metaanalysis of observational studies. Pharmacy World and Science 2002; 24(2):46-54
Patricia L. Harrison, Pamela A. Hara, James E. Pope et.al. The Impact of Postdischarge Telephonic Follow-Up on Hospital Readmissions. Population Health Management Feb 2011; 14(1):27-32.
Amrita P, Roomi M.T. Scenario of Pharmacovigilance and ADR Reporting among pharmacists in Delhi. Indian Journal of Pharmacy Practice Oct-Dec 2011;4(4):29-38.
Jerry H. Gurwitz and Jerry Avorn. The Ambiguous Relation between Aging and Adverse Drug Reactions. Ann Intern Med 1991; 114(11):956-966.
Straand J, Rokstad K. Elderly patients in general practice: diagnoses, drugs and inappropriate prescriptions. A report from the Møre & Romsdal Prescription Study. Family Practice-an international journal 1999; 16(4):380-388
Gillian Cunningham, Timothy R.P. Dodd, David J. Grant et.al Drug- related problems in elderly patients admitted to Tayside hospitals, methods for prevention and subsequent reassessment. Oxford journal, Age and Ageing 1997; 26:375-382.
L. J. G. Veehof, R. E. Stewart, B. Meyboom-de Jong et al. Adverse drug reactions and polypharmacy in the elderly in general practice. Eur J Clin Pharmacol 1999; 55: 533-536.
Marilyn Malone, Amanda Hill, Geoff Smith. Three month follow up of patients discharged from a geriatric day hospital. Oxford journal, Age and Ageing 2002; 31:471-475.
Munir Pirmohamed, Sally James, Shaun Meakin et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ. JULY 2004; 329.
Joseph O Fadare, Segun Matthew Aghoola, Olumide Augustine Opeke et al. Prescription pattern and prevalence of potentially inappropriate medications among elderly patients in a Nigerian rural tertiary hospital. Therapeutics and Clinical Risk Management 2013; 9: 115–120.
Muhsina Taskeen, Dr. Anitha. N, Syed Rashid Ali et al. A study on drug prescribing pattern in geriatric patients in Hyderabad Metropolitan. Journal of Drug Delivery & Therapeutics 2012; 2(5):109-113.
C.M. Lindley, M.P. Tully, V. Paramsothy et.al. Inappropriate Medication is a major cause of adverse drug reactions in elderly patients. Oxford journal, Age and Ageing 1992; 21:294-300.
Veena D. R, Padma L, Sapna Patil. Drug prescribing pattern in elderly patients in a teaching hospital. Journal of Dental and Medical Sciences Sep-Oct 2012; 1(5):39-42.
Lohani SP, Thapa P, Aryal UR et al. Polypharmacy and Geriatric Patients: Patterns of Prescribing in the Tribhuvan University Teaching Hospital in Nepal. Journal of Nepal Health Research Council April 2006; 4(1).
Mahesh Kumar V.P, Dhanapal C.K. Drug prescribing pattern in geriatric patients in a rural teaching hospital. Unique Journal of Pharmaceutical and Biological Sciences 2013; 1(1):16-18.
Sujata Sapkota, Nawin Pudasaini, Chandan Singh et al. Drug prescribing pattern and prescription error in elderly: A retrospective study of inpatient record. Asian Journal of Pharmaceutical and Clinical Research 2011; 4(3):129-132.
Emily R. Hajjar, Angela C. Cafiero, Joseph T. Hanlon. Polypharmacy in elderly patients. The American Journal of Geriatric Pharmacotherapy December 2007; 5(4):345-351.
Mandavi, Sanjay D’Cruz, Atul Sachdev et.al. Adverse drug reactions in a ambulatory elderly patients, Indian Journal of Medical Research September 2012; 136: 404- 410.
Franceschi M, Scarcelli C, Niro V et.al. Prevalence, clinical features and avoidability of adverse drug reactions as cause of admission to a geriatric unit: San Giovanni Rotondo in Italy. Drug Safety June 2008; 31(6):545-56.
Cyndie K Mannesse, Frans H M Derkx, Maria A J de Ridder et.al, Adverse drug reactions in elderly patients as contributing factor for hospital admission: cross sectional study. BMJ 1997; 315:1057.
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