Actual drug-related harms in residential aged care facilities: a narrative review

ABSTRACT

Introduction

Older people in residential aged care facilities (RACFs) have a high risk of safety issues and concerns about the potential quality of care received. This narrative review investigates the types of actual drug-related harms, their prevalence, reporting of any standard definitions for these harms, and their identification methods.

Areas covered

The authors conducted a systematic search on Ovid Embase, Ovid Medline, and PubMed from March 2001 to March 2021. This narrative review included all types of studies targeting aged care residents aged 65 years and above with actual drug-related harms.

Expert opinion

The prevalence of actual drug-related harms in residents ranged from 0.07% to 63.0%. Falls, drug-drug interactions, neuropsychiatric symptoms, anaphylaxis, urinary tract infection, hypoglycemia, hypokalaemia, and acute kidney injury are the most common drug-related harms in older residents. Psychotropic drugs are the most common drug class implicated in these harms. Evidence related to the association between individual psychotropic drugs and injury, or harm is also lacking. Due to the variation in study duration, reported prevalence, identification methods, and absence of a definition for actual drug-related harms in most studies, further research is mandated to understand the prevalence and clinical implications of drug-related harms in older residents.

KEYWORDS:

• Harms
• ADEs
• older people
• RACFs
• drug-related harm
• medication-related harm

Article highlights

• Older people in residential aged care facilities (RACFs) frequently experience actual drug-related harms such as falls, drug-drug interactions and neuropsychiatric symptoms. The drug class most implicated in these harms was psychotropic drugs. However, evidence related to the association between individual psychotropic drugs and adverse drug events (ADEs) is lacking.

• The prevalence of actual drug-related harms in older residents ranged from 0.07% to 63.0%. Similarly, the prevalence of falls among older people in RACFs ranged from 11.0% to 60.5%.

• Chart review was the frequently utilised method of ADE identification (n=14, 63.6%).

• There is a lack of specifying standard definitions for drug-related harms. Majority studies (n=19, 86%) did not report ADE definition.

• Studies are lacking in evaluating the risk factors contributing to the different types of actual drug-related harms in RACFs. Identifying risk factors contributing to actual drug-related harms is vital for uncovering causes and types of problems and evolving strategies for harm reduction.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14740338.2022.2084071

Additional information

Funding

This paper was not funded.