Predicting risk of adverse drug reactions in older adults
Open accessAbstract
Adverse drug reactions (ADRs) are common in older adults, with falls, orthostatic hypotension, delirium, renal failure, gastrointestinal and intracranial bleeding being amongst the most common clinical manifestations. ADR risk increases with age-related changes in pharmacokinetics and pharmacodynamics, increasing burden of comorbidity, polypharmacy, inappropriate prescribing and suboptimal monitoring of drugs. ADRs are a preventable cause of harm to patients and an unnecessary waste of healthcare resources. Several ADR risk tools exist but none has sufficient predictive value for clinical practice. Good clinical practice for detecting and predicting ADRs in vulnerable patients includes detailed documentation and regular review of prescribed and over-the-counter medications through standardized medication reconciliation. New medications should be prescribed cautiously with clear therapeutic goals and recognition of the impact a drug can have on multiple organ systems. Prescribers should regularly review medication efficacy and be vigilant for ADRs and their contributory risk factors. Deprescribing should occur at an individual level when drugs are no longer efficacious or beneficial or when safer alternatives exist. Inappropriate prescribing and unnecessary polypharmacy should be minimized. Comprehensive geriatric assessment and the use of explicit prescribing criteria can be useful in this regard.
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Common adverse drug interaction-related events include neuropsychological symptoms (delirium), acute renal failure, and hypotension.
“Other common adverse drug interaction-related adverse events include neuropsychological symptoms (delirium), acute renal failure, and hypotension [585].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [585]
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Izquierdo, M., de Souto Barreto, P., Arai, H., Bischoff-Ferrari, H. A., Cadore, E. L., Cesari, M., Chen, L.-K., Coen, P. M., Courneya, K. S., Duque, G., et al. (2025) · The Journal of nutrition, health and aging · doi:10.1016/j.jnha.2024.100401 · Cited by 273 · see citing works
- Authors
- Lavan, A. H., & Gallagher, P.
- Affiliations
- Cork University Hospital (IE)
- Corresponding author
- Gallagher, Paul
- ORCID
- Lavan, Amanda Hanora
- Venue
- Therapeutic Advances in Drug Safety
- Publisher
- SAGE Publications
- Published
- 2015-11-16
- Volume
- 7
- Issue
- 1
- Pages
- 11-22
- ISSN
- 2042-0986 (ISSN-L)
- 2042-0994
- PMC
- PMC4716390
- OpenAlex
- W2284826680
- Cited by
- 455
- References
- 85
- Citations by year
- 2026: 25 · 2025: 52 · 2024: 57 · 2023: 75 · 2022: 59 · 2021: 58 · 2020: 44 · 2019: 36 · 2018: 25 · 2017: 18 · 2016: 6
- FWCI
- 1.70
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Therapeutic Advances in Drug Safety (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Keywords
- adverse drug reactions, older adults, polypharmacy, inappropriate prescribing, deprescribing, medication reconciliation, comprehensive geriatric assessment, falls, orthostatic hypotension, delirium, renal failure, gastrointestinal bleeding, intracranial hemorrhage, comorbidities, prescribing criteria
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