Document resource
Background Adverse drug reactions (ADR) and adverse drug events (ADE) are unintended, harmful responses to a medication and can vary in severity, from mild side effects to severe or life-threatening conditions. Older adults are at higher risk due to polypharmacy and age-related changes. The objective was to investigate the association between ADR-related hospital admissions and ADEs in primary care in relation to health related quality of life (HRQOL), functional decline, and accident and emergency (A&E) visits over time.Methods Two cohorts were used: the ADAPT dataset and the CPCR dataset (both in Ireland). ADAPT included 230 patients (93 exposed with ADR-related hospital admission) and the outcomes were: EQ-5D-5L, Groningen Frailty Index (GFI), and A&E visits. A baseline questionnaire was performed in 2016–2017 and a follow-up questionnaire 3 months later. CPCR included 605 patients (465 exposed with ADE) and the outcomes were: EQ-5D-3L, Vulnerable Elders Survey (VES), and A&E visits. A baseline questionnaire was performed in 2010–2011 and a follow-up questionnaire 24 months later. Multivariate regressions examined the link between ADR-related admissions/ADEs and HRQOL (EQ-5D-5L/3L), functional decline, and A&E visits, adjusted for age, sex, comorbidity, and polypharmacy.Results ADAPT patients were older (median age 79 vs. 75), had more morbidity (Charlson score ≥3: 40% vs. 7%), and more polypharmacy (≥10 medications: 38% vs. 31%) than CPCR patients. In ADAPT, frailty increased in both ADR (68% to 85%) and non-ADR (74% to 85%) groups (p<0.01). A&E visits decreased (p<0.001), and HRQOL did not change significantly. In CPCR, HRQOL decreased for both ADE (p=0.001) and non-ADE (p=0.044) groups. Functional decline risk rose for both (ADE: p=0.020, non-ADE: p=0.039). A&E visits increased (p<0.001). ADE patients had lower HRQOL and more frailty (p<0.001). No significant changes between ADR and non-ADR and ADE and non-ADE.Conclusion The ADAPT cohort showed slight improvements in HRQOL, while the CPCR cohort showed no significant changes. No significant impact of ADR/ADE on HRQOL, functional decline, or A&E visits was found, though trends suggest severe morbidity may influence outcomes. This study highlights the need for further research to understand the impact ADRs/ADEs have on older patients lives. Such research will not only provide greater understanding of the impact of medication-related harm on older people but will also help to prevent, identify, and manage adverse effects of medication, ultimately improving the healthcare and well-being of older patients.