| Objective:To investigate the difference between the elderly and the adults in adverse drug reaction(ADR) and the characteristics of ADR in the elderly.Methods:The self-designed questionnaire of ADR was used for the cross-sectional study .1778 patients with age≥18 years old who discharged in the department of geriatrics of the second xiangya hospital of central south university during May 1, 2007 to Feb 28,2008 were divided into two groups the adults (<60 years old)and the elderly(≥60 years old). 383 patients (484 times)were suffered from ADR (312 patients/406 times in the elderly and 71 patients/78 times in the adults).To investigate the difference between the two groups in incidence, risk factors, clinical manifestations , diagnosis and treatment.Results:The incidence of ADR was 22.9% in the elderly ,which was significantly higher than that in the adults (17.1%,p<0.05). There was positive correlation (r=0.460,p=0.005) between age and the incidence of ADR in the elderly and no correlation in the adults (r=-0.039,p=0.829) .The prevalance of liver and renal dysfunction in the elderly was significantly higher than that in the adults (p<0.05). The incidence of history of ADR was 30.5% in the elderly, which was significantly higher than that in the adults (12.7%, x~2=9.236, p<0.05). The basic diseases was 6.7±2.3 species in the elderly, which was significantly higher than that in the adults (4.2±2.0 species ,F=72.861,p<0.05). The prevalance of hyperten-tion,coronary heart disease, infectious disease and cerebrovascular disease in the elderly were obviously higher than those of in the adults (p<0.05), but the prevalance of diabetes and tumor were no statistical difference between the two groups(p>0.05). The number of drugs was 7.9±3.4 kinds in the elderly, which was significantly higher than that in the adults (5.8±3.2 kinds ,t=-4.938, P<0.05). ADRs were induced by 20 major categories of drugs in the elderly, the first 8 categories were antimicrobial agents, circulatory system drugs, hormone and related drugs (major hypoglycemic drugs), central nervous system drugs, urinary system drugs, hematologic and hematopoietic medication,antitumor drug and traditional Chinese medicine.ADRs were induced by 15 major categories of drugs in the adults, the first 6 categories were circulatory system drugs, hormone and related drugs (major hypoglycemic drugs), antimicrobial agents,central nervous system drugs, antitumor drug and traditional Chinese medicine.The average days of hospitalization were 40.7±56.9 days in the elderly ,which were significantly longer than that in the adults (20.3±21.7 days, Z=-5.095, P<0.05). There was positive correlation (r=0.964,p=0.036) between the average days of hospitalization and the incidence of ADR in the elderly and no correlation in the adults (r=-0.291, p=0.709). The incidence of drug incompliance was 12.3% in the elderly ,which was significantly higher than that in the adults (3.8%, x~2=4.813,P<0.05) . The incubation period of ADR in the elderly was longer than that in the adults (p<0.05).There was no statistical difference in the course of ADR between the two groups(p>0.05).In the elderly, the incidences of metabolic and nutritional disturbance ( hypoglycemia and hypokalemia), cardiovascular system damage, systemic damage ,dual infection and pentalagy of senile disease of ADR were higer than those in the adults (p<0.05),but the incidence of neurological symptoms was lower (p<0.05).There were no statistical difference in the incidences of gastrointestinal system damage, impairment of skin and its appendages, hepatobility system damage, respiratory system injury,the local lesion, endocrine system damage, urinary system damage, blood system damage (p>0.05).The incidence of repeated ADR was 22.2% in the elderly, which was significantly higher than that in the adults (8.5%, x~2=4.980, P<0.05) . There was no statistical difference in the incidence of drug-related hospital admissions between the elderly and the adults ( 5.2% vs2.9%, x~2=3.794, P>0.05) . The incidence of definite ADR in the elderly was significantly higher than that in the adults(Z=-2.712, P<0.05). In both groups,type A was the major type, while the incidence of type A and Severe degree of ADR in the elderly were significantly higher than those in the adults (P<0.05) . The incidence of required drug withdrawal and symptomatic treatment in the elderly were significantly higher than those in the adults (P<0.05) .There was no statistical difference in the prognosis of ADR beween the two groups (Z=-1.529,P>0.05) , but the mortality in the elderly was 0.6% . The incidence of prevention was significantly higher than that in the adults (P<0.05) .Conclusions:1. The high incidence of adverse drug reaction in the elderly was concerned with advancing age, liver and renal dysfunction,history of ADR,multiple disease, polypharmacy, incompliance and longer hospitaliation days.2. The incubation period of ADR was long and clinical charactristics with metabolic and nutritional disturbance (hypoglycemia and hypokalemia), cardiovascular system damage ,systemic damage ,dual infection and pentalagy of senile disease of ADR were seen frequently in the elderly .The incidence of repeated ADR was higher.3. Type A and severe degree of ADRs in the elderly were seen frequently.4. ADRs in the elderly were mostly required drug withdrawal and symptomatic treatment. ADR had good prognosisand can been prevented well.
|
PDF Full Text Request