Healthy Skepticism Library item: 836

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Publication type: news

Welsh M.
Drug reactions harm, even kill, elderly: Study
The Toronto Star 2005 Feb 25

Full text:

A study that examined medication records of nursing homes in Toronto and Connecticut has found that preventable drug reactions are seriously harming many patients.

Fragile, elderly residents of nursing homes are being seriously harmed and sometimes killed by drug reactions that are mostly preventable, says a new study.

Bad reactions to medication in nursing homes are far more common than previously documented, according to the study ‹ which examined records at Toronto’s renowned Baycrest Centre for Geriatric Care and a Connecticut nursing home.

“This is huge,” said geriatrician Dr. Paula Rochon, a co-author of the study, published yesterday in the American Journal of Medicine, and senior scientist at Baycrest. “The results of this study should take a big lead in saying that adverse drug events are an issue that we need to look at much more carefully,” said Rochon. “It’s a very big issue across the industry.”

The solution is two-fold, the study concludes:
Nursing homes must make greater use of computer data to tell doctors and nurses what medications work or don’t work for each patient.

As well, nursing home administrators must give families more information about their relatives’ care so they can watch for symptoms.

Rochon said that as a result of the study, Baycrest created a computer system that red-flags potential problems when a doctor uses it to prescribe a drug.

The system, which can be accessed by laptop or from a doctor’s home computer, provides information on the residents’ drugs, allergies, blood work and problems caused by the combinations of certain drugs.

Baycrest, home to the 472-bed Apotex Centre, Jewish Home for the Aged, is now in the midst of a study of how well the new computer system works.

Researchers combined resident records from both nursing homes, for a total of 1,229 beds. They did not break down the data separately for Baycrest and the Connecticut home, which would not allow the release of its name.

They found 815 adverse drug reactions over eight months in one facility and nine months in the other, from 2000 to 2001. Of those, 188 were classified as serious, 33 were called life-threatening and four were fatal.

Serious drug reactions included delirium, falls resulting in fractures, bleeding requiring transfusions, hypoglycemia and kidney problems.

Less serious problems included skin rashes, falls without broken bones, bleeding not requiring transfusion or hospitalization, and medication-induced drowsiness.

Researchers, who were also based at the University of Massachusetts Medical School, say the results of the study are more complete than past research.

That’s because this is the first study to scrutinize homes attached to teaching hospitals, which are generally known to keep detailed data that would give a more accurate picture of the problem’s scope.

As well, the team, including a research pharmacist, scoured each resident’s records to uncover problems that previously went undetected.

The study found that the drug reactions were typically caused by errors in prescribing and monitoring the drugs, including the use of drugs that adversely reacted to each other, and failing to watch closely for side effects.

Antipsychotic drugs caused the most harm.

Some nursing homes give these to residents with cognitive problems. During the Toronto Star’s 2003 investigation into nursing home care, some families complained their loved ones had been given the drugs to keep them quiet because they were bored and unruly.

Other drugs that caused the most reactions were anti-coagulants, diuretics, and anti-epileptics.

The study also found:

42 per cent of all adverse reactions were preventable.

61 per cent of the serious, life-threatening and fatal reactions were preventable.

The most frequent types of preventable reactions included abdominal pain, diarrhea, constipation, bleeding and dehydration.

Among the elderly, problems such as dehydration and diarrhea can lead to severe health problems, not to mention a major drop in quality of life in homes that limit the number of diaper changes each day.

“This is a wake-up call for nursing homes,” said Lois Dent, president of Concerned Friends of Ontario, a nursing home advocacy group.

“The elderly are fragile and drugs can affect them more seriously than others. The Ministry of Health needs to alert the home administrators and doctors to look into this and tell them to smarten up in the way they are prescribing drugs.”

Ontario nursing homes are required to file an “unusual occurrence report” each time a resident experiences a drug reaction. However, data previously obtained by the Star through a Freedom of Information request showed these problems are either under-reported or often overlooked.

Over a five-year period, from 1998 to 2003, there were only 38 medical drug entries reported from more than 400 nursing homes across the province.

Baycrest’s Rochon said the low numbers aren’t surprising.

“Reactions are much more subtle than people think ‹ they don’t really see them. We need to make people more aware so that a nurse would look at this and say this might be related to a drug and report it.

“Until we make people aware of this issue it is impossible to fix it.”