Emma Jennings1,2, Kevin Murphy3, Paul Gallagher1, Denis O’Mahony1,2
1Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
2Department of Medicine, University College Cork, Cork, Ireland
3School of Pharmacy, University College Cork, Cork, Ireland
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 olderadults
in terms of incidence and prevalence, most commonly involved drug classes, severity,
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
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
11 studies were analysed, involving 4424 patients; 24%  had experienced ADRs.
7 studies reported severity (n = 707); 31%  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%  cardiovascular system, 17%  central
nervous system, 16%  clotting pathways, 13%  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.