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One in three older adults experience harm from medicines

Professor Chakravarthi Rajkumar, Chair of Geriatrics and Stroke Medicine at BSMS

Up to 37% of older patients experience medication-related harm following hospital discharge, shows a new study involving the Brighton and Sussex Medical School (BSMS).

In addition to distress and potential dangers to patients, this harm costs the NHS in England an estimated £396 million annually.

The first of its kind in the UK, this major study by BSMS and King’s College London, published in the British Journal of Clinical Pharmacology, involved five hospitals and 1,280 patients (average age 82 years) in southern England.

The PRIME study investigated the burden of medication-related harm in the eight weeks post hospital discharge: senior pharmacists interviewed patients and carers, reviewed GP records and analysed hospital readmissions to determine medication-related harm. All cases were then scrutinised by an expert committee of senior geriatricians and pharmacists.  

The study found that more than one in three patients (37%) experienced harm from their medicines within two months of hospital discharge, and that this was potentially preventable in half of the cases. Medication-related harm was most commonly found to occur from the toxicity of the medicine itself and in a quarter of cases from poor adherence.

The medicines found to pose the highest risk were opiates, antibiotics and benzodiazepines. Patients suffered a range of conditions including serious kidney injury, psychological disturbance, irregular heart rhythms, confusion, dizziness, falls, diarrhoea, constipation and bleeding.

Professor Chakravarthi Rajkumar, Chair of Geriatrics and Stroke Medicine at BSMS, and Senior Author, said: “As the use of medicines in the ageing population is rapidly increasing, it is vital that we improve awareness among clinicians of the harm that medicines commonly cause. The risk-to-benefit analysis is particularly complex in the older population. Once medicine is initiated, there should be a tentative stop date, monitoring of correct usage and vigilance for adverse reactions. 

“When a patient is due for surgery, full informed consent is taken after the risks and benefits are clearly discussed.  Medication-related harm can be life-threatening and similarly decisions to prescribe high-risk medicines should be taken after a comprehensive discussion with the patient. While the cost implications are significant, the magnitude extends beyond finances to adversely affect the quality of life for patients and families.”

The study found there was a substantial use of NHS services attributable to the medication-related harm. Four out of every five patients who experienced harm then utilised NHS services, and 8% of patients were readmitted to hospital as a consequence. Based on these results, the estimated cost to the NHS in England is £396 million annually.  

Professor Graham Davies, Professor of Clinical Pharmacy and Therapeutics at the Institute of Pharmaceutical Science, King’s College London and Senior Author, said: “In order to reduce the number of older people being harmed by their medicines, it’s important that their medication regimens are closely monitored within the community.  Pharmacists should work in close collaboration with all prescribers to support the safe use of medicines.”

Dr Khalid Ali, Senior Lecturer in Geriatrics at BSMS and Chief Investigator of the study, added: “Supporting health literacy within the older population, specifically in terms of medication usage, is crucial. There is also an increasing volume of work on the potential benefits of ‘deprescribing’ medicines in older adults, whereby medications are reduced safely in a way that is acceptable to patients.”  

Brighton and Sussex Medical School (BSMS) is a partnership between the Universities of Sussex and Brighton and the local NHS health community.

Posted on behalf of: BSMS
Last updated: Friday, 3 August 2018


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