Vol XXIX, Dec 06

Med errors and ADEs are complex issues that involve many misconceptions, conflicting opinions, and lack of information. He discussed a decades-old study that showed physicians saw antihypertensive drugs as having a more positive effect on patients than these individuals themselves or their relatives thought the medications had. "Patients had very different opinions about whether the drug improved or helped them," Gurwitz noted. He added, "The take message is that as health care providers, we are not good at recognizing subtle side effects or the impact of even obvious side effects on patients."

Several factors influence drug effects and the risk of adverse effects in the elderly, Gurwitz observed, and many of these are intuitive—multiple co-existing illnesses, polypharmacy redundant effects and drug-drug interactions, pharmacologic changes with aging, limited knowledge base, and medical errors (issue of patient safety).

Gurwitz lamented the fact that much is still unknown about the effects of medications on the elderly, mainly because these individuals have been eliminated from research studies over the years. "Advanced age has been a primary reason for study ineligibility, and there has been a systematic exclusion of patients over age 75," he explained. However, he observed that "things are improving over time. Fewer studies explicitly exclude older people." He cited statistics showing that while elderly patients were excluded from 66% of studies between 1981 and 1990, only 32% of studies excluded this population between 1996 and 2000. We need more elderly patients involved in studies, and Gurwitz encouraged his audience to involve their patients in research whenever possible.

In the meantime, there is much that can be done to address med errors in long term care settings. For example, he noted, a systems-based approach to medication errors makes sense. After all, he said, the most important causes of error are faulty systems or design. Instead of the traditional approach to dealing with medication errors—name, blame, shame, and maim—a systems approach assumes that individuals are doing their best.