A Nurse’s Guide to Identifying Adverse Drug Reactions in Elderly Residents

It’s a little-known fact that adverse drug reactions (ADRs) increase with age. For residents in skilled nursing facilities, this risk may lead to an uptick in hospitalizations and costly complications. 

The good news? More than half of all ADR-related hospitalizations are preventable. This guide highlights the nurse's role in identifying and preventing adverse drug reactions in elderly residents. 

What is an Adverse Drug Reaction?

An ADR is defined as any harmful or unpleasant reaction resulting from medication use that requires specific interventions.

A side effect, on the other hand, is an expected additional effect of a medication, often not harmful but may be bothersome.

Older adults are vulnerable to ADRs due to age-related changes in how their bodies process medications, higher comorbidity rates, polypharmacy (taking multiple medications), inappropriate prescribing practices, and inadequate monitoring. 

Adverse Drug Reaction vs Allergic Reaction

Adverse drug reactions are broader and can include responses that are not immune-mediated, such as dose-related effects or predictable side effects. 

Allergic reactions specifically involve the body's immune system reacting to a medication, often resulting in symptoms like itching, rash, swelling, or even severe anaphylaxis in some cases.

Is an Adverse Drug Reaction Preventable?

While it may be challenging to completely avoid ADRs, steps can be taken to reduce their occurrence. 

Here are a few ways to reduce the likelihood of an unwanted outcome:

• Conduct regular medication reviews. Assess medication necessity, effectiveness, and potential interactions to identify and address any inappropriate or unnecessary medications.
• Deprescribe as much as possible. In some cases, deprescribing, which involves discontinuing medications that are no longer beneficial or may pose risks, minimizes the risk of drug interactions.
• Regularly educate residents and staff. Educating elderly patients and their caregivers about their medications, including potential side effects and warning signs of ADRs, can empower them to actively participate in their care and report any concerning symptoms promptly.

Staff should pay attention to and be vigilant when:

• New or unusual symptoms that emerge after starting a new medication.
• Unexpected changes in a patient's condition that cannot be readily explained.
• There is a worsening of pre-existing conditions without a clear rationale or exacerbating factors.

When managing a suspected adverse drug reaction, nursing staff should promptly assess the patient's condition, document all relevant details, and notify the healthcare provider for further instruction.

Types of Drug Reactions with Examples

Reactions associated with ADRs fall into two main categories: Type A and Type B.

Type A Drug Reaction

These reactions occur due to the known pharmacological properties of the drug. They are predictable and typically happen in any individual when exposed to the medication. 

Type A reactions account for a significant portion, around 85% to 90%, of all ADRs. 

For instance, the adverse side effects of statin drugs fall into this category as they are predictable reactions resulting from the drug's pharmacological properties, such as muscle pain or weakness. 

This is because side effects, which are expected and known reactions to a drug, also fall under Type A reactions.

Type B Drug Reaction

While Type A reactions are dose-related and predictable, Type B reactions are non-dose related and can be highly variable among individuals. 

Type B reactions are less common but are often severe and potentially fatal. 

Examples of Type B reactions include severe allergic reactions, drug-induced liver injury, and certain types of drug-induced autoimmune disorders.

Keep residents safe. Partner with Prime Care Pharmacy to enhance medication management, ensure the safety of residents, and prevent adverse drug reactions.