In-hospital adverse drug reactions in hospitalised older adults - a systematic review

Background: Recent studies indicate that 1 in 4 older people experience an ADR in hospital. This systematic review [SR] aims to evaluate in-hospital ADRs in hospitalised older-adults in terms of incidence and prevalence, most commonly involved drug classes, severity, and consequences. Methods: Using PRISMA methodology [PROSPERO registration CRD42018079095], we systematically searched PubMed, Embase and Ebsco-CINAHL, Cochrane Library and library hosted academic sources, Google® scholar, and ‘grey’ literature. Search terms included aged, ADRs, hospitalized, multi-morbid, polypharmacy and hospital-acquired. A hand search of bibliography lists from relevant editorials and systematic reviews was conducted. We included studies of all languages and all dates up to and including the date of the final search [15/01/2018]. We included all studies that reported ADRs either as a primary or secondary outcome in patients aged ≥ 65 years who were hospitalised at time of ADR occurrence. Two researchers screened all papers for inclusion, risk of bias and data extraction. Results: Initial search yielded 1721 abstracts, 200 underwent full text screening. 60 papers were potentially suitable for inclusion; 48 papers contained pooled all-ages data, 12 papers reported directly on ADRs in our age cohort [2 papers reported the same data]. 11 studies were analysed, involving 4424 patients; 24% [1064] had experienced ADRs. 7 studies reported severity (n = 707); 31% [220] of ADRs were described as severe. 5 papers reported on post-ADR outcomes i.e. hospital length of stay [LOS, n = 3], death [n = 1] and functional decline [n = 1]. Frequency of culprit drug-groups by system were described in 6 papers [672 ADRs]; 43% [291] cardiovascular system, 17% [114] central nervous system, 16% [112] clotting pathways, 13% [90] anti-microbials. Conclusion: One in four over 65 years experience an ADR during hospitalisation, one third being severe, and almost half cardiovascular system drugs. Clinical outcomes associated with ADRs are generally poorly described in the literature.Poster presentatio