geriatrics
Prevention of Iatrogenic Complications in Older Adults
Risk Factors for Iatrogenic Complications
The first step in prevention is to identify patients at high risk. Risk factors include having multiple chronic diseases, having multiple clinicians, taking multiple medications, and being hospitalized. The greater the number of chronic diseases, the greater the risk that treatment of one disease will exacerbate other diseases. For example, treatment of arthritis with a nonsteroidal anti-inflammatory drug (NSAID) may exacerbate Heart Failure (HF) , Having multiple physicians can result in uncoordinated care and polypharmacy. Consultation among multiple physicians every time one of them sees a common patient is difficult. As a result, a patient’s therapeutic regimen is frequently changed without the input of the patient’s other physicians, thereby increasing risk of iatrogenic complications. Taking multiple medications concurrently and having multiple chronic diseases markedly increase risk of adverse Drug-Related Problems in Older Adults or Risks due to hospitalization include hospital-acquired infection, polypharmacy, and transfusion reactions. Hospitalized patients who have dementia or who are immobilized (eg, after surgery) are at high risk of iatrogenic complications (eg, pressure sores, deep venous thrombosis, urinary retention, delirium). Medical technology may contribute to iatrogenic complications, including sudden death or myocardial infarction after valvular replacement surgery, stroke after carotid endarterectomy, fluid overload after transfusions and infusions, unwanted prolongation of life via artificial life support, and hypoxic encephalopathy after potentially life-prolonging cardiopulmonary resuscitation (CPR). 