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Medication-related harms (MRH) encompasses any adverse event resulting from the use of medications, including adverse drug reactions (ADRs), medication errors, non-adherence, and drug interactions. In elderly populations, MRH is particularly concerning due to age-related physiological changes, multiple chronic conditions, and the increased likelihood of polypharmacy. These factors collectively heighten the risk of negative outcomes associated with medication use in older adults.​
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Global statistics on medication-related harms in the elderly
MRH is a significant global health issue among the elderly. In the United States, approximately 200,000 older adults may die annually due to medication-related problems. In the United Kingdom, a study found that one in three older adults experienced MRH following hospital discharge, with 50% of these cases being potentially preventable. In India, up to 60% of medications prescribed to the elderly are taken incorrectly or not at all, leading to a high incidence of medication errors. Gender differences have also been observed; for instance, a German study reported that elderly females were more susceptible to ADRs, accounting for 7.6% of hospital admissions.​
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Types of medication-related harms
Medication errors
These include mistakes in prescribing, dispensing, or administering medications.​Adverse Drug Reactions (ADRs)
Unintended and harmful reactions to medications, often predictable and preventable with proper monitoring .​Non-adherence
Failure to take medications as prescribed, which can be intentional or unintentional, leading to suboptimal therapeutic outcomes.​Drug-drug interactions
Concurrent use of multiple medications can lead to interactions that diminish efficacy or increase toxicity.​Therapeutic failures
When medications do not achieve the intended health outcomes, possibly due to incorrect usage or resistance.
Causes of medication-related harms
Polypharmacy
The use of multiple medications increases the risk of interactions and side effects .​Look-Alike, Sound-Alike (LASA) medications
Medications with similar names, colours, shapes can lead to dispensing and administering errors.​Physiological changes
Age-related changes in drug metabolism and excretion can alter drug efficacy and safety.​Cognitive impairment
Memory issues can lead to incorrect medication usage.​Inadequate monitoring
Lack of regular review of medication regimens can result in continued use of inappropriate medications.
Consequences and complications
Medication-related harm (MRH) in older adults can result in a wide spectrum of negative health outcomes, ranging from mild discomfort to life-threatening events. Due to their age-related vulnerabilities and comorbidities, elderly individuals are at an elevated risk of suffering severe consequences, even from minor medication issues. These complications extend beyond individual health, impacting healthcare systems, caregivers, and overall quality of life.
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- Hospital visits and admissions
Many elderly people end up in the emergency department or hospital because of medication problems, such as side effects, wrong doses, or drug interactions. These can lead to longer hospital stays and slower recovery. - Higher risk of death and serious illness
In severe cases, MRH can cause life-threatening complications like internal bleeding, heart problems, or infections. Studies show that thousands of elderly deaths each year are linked to preventable medication issues. - Falls and injuries
Some medications can cause dizziness, low blood pressure, or drowsiness, leading to falls. Falls in the elderly can cause broken bones, head injuries, and permanent loss of mobility. - Confusion and memory problems
Certain drugs, especially those affecting the brain, can cause confusion or worsen memory in older adults. This is especially dangerous for those with dementia, as it can make behaviour worse and increase the risk of accidents. - Loss of independence
Side effects like fatigue, weakness, or urinary issues can make it hard for seniors to take care of themselves. This may lead to more dependence on caregivers or needing to move into a care facility. - Emotional and mental stress
Taking too many medications or dealing with unpleasant side effects can cause anxiety, depression, and frustration for both the elderly and their caregivers. - Increased healthcare costs
Medication-related harms often lead to extra doctor visits, hospital stays, and treatments, raising costs for both families and burden the healthcare system.
Prevention strategies
Regular medication reviews
Periodic assessment of medication regimens to identify and discontinue unnecessary drugs.​Patient and caregiver education
Informing patients and caregivers about proper medication use and potential side effects.​Use of technology
Implementing electronic prescribing and monitoring systems to reduce errors.​Interdisciplinary approach
Collaboration among healthcare providers to ensure comprehensive care.​Simplifying regimens
Reducing the number of medications and dosing frequency to enhance adherence.​
Conclusion
Medication-related harm in the elderly is a prevalent and preventable issue that necessitates vigilance from all parties involved in patient care. Healthcare providers, caregivers, and the elderly themselves must work collaboratively to ensure safe medication practices. Through regular reviews, education, and the use of technology, the risks associated with medication use in older adults can be significantly reduced, leading to improved health outcomes and quality of life.
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