Tools to predict adverse drug reactions in older adults lacking

There is currently no standard and well-validated tool to predict adverse drug reactions (ADRs) in older adults, reports a recent meta-analysis.

Further study is needed in this field to refine existing methods or develop new ones, according to the researchers.

Drawing from the online databases of Medline, Embase, CINAHL, Web of Science, PubMed, and ProQuest, the researchers identified 18 eligible studies. Only those that enrolled older patients (≥60 years of age) with morbidity and polypharmacy were included. All studies used an instrument to predict or detect ADRs in this patient population.

ADR detection tools used in the included studies ranged from simple to complex. Most papers (n=10) used the first or second versions of the Screening Tool of Older People's Prescriptions/Screening Tool to Alert to Right Treatment (STOPP/START) instrument to screen for potentially inappropriate medications.

Other such tools used included Beers Criteria 2012 or 2015 (n=4), the Systematic Tool to Reduce Inappropriate Prescribing (STRIP; n=2), the Norwegian Nursing Home Criteria (n=1), or an in-house computerized alert system (n=1).

The study’s primary outcome was the number of predicted or prevented ADRs or adverse events, which was reported in three studies. None showed a significant impact of the employed detection tools.

Meanwhile, three studies reported on the reduction in ADRs or adverse events. Two of these showed significant improvements in discontinuations or dose reductions in patient groups that used the ADR prediction tools. Similarly, these tools also led to a significant reduction in polypharmacy.

“The complexity of the tools developed to date and the outcome measures and methods used for validating their performance vary,” the researchers said. “There is no definitive validated assessment tool for widespread use in older patients.”