Q&A: Discussing potential adverse events of new medications with older adults

Many older adults do not recognize potential adverse events associated with their new medications, according to a study published in the Journal of General Internal Medicine.

Researchers conducting the study evaluated patients’ ability to identify their new medication dose, the number of pills they need to take, how often they need to use the medication, how long they need to take the medication and potential adverse events associated with the medication.

They performed a secondary mixed methods analysis to compare patients’ survey responses on new medications with the information they were given by the prescribing physician based on audio recordings from the visit.

A total of 81 patients aged 50 years and older who received 111 newly prescribed medications were included in the study.

Researchers determined that patients correctly identified the number of pills, frequency and duration of use and dose of the medications for 70% of all new medications, regardless of whether the prescribing physician discussed them during the visit.

Additionally, they found that patients said their new medication was not associated with adverse events for 55% of medications that physicians had not mentioned potential adverse events and 22% of medications that physicians had discussed potential adverse events.

According to researchers, the transcribed office visits showed that some potential reasons patients believed their medications did not have potential adverse events were that the prescribing physician did not mention them in the visit or did not refer to them as “side effects,” that patients were prescribed multiple different new medications in the same visit, or that patients may not have been engaged in the conversation on new medications with their physician.

Healio Primary Care spoke with study coauthor Derjung M. Tarn, MD, PhD, assistant clinical professor of family medicine at the David Geffen School of Medicine at UCLA, to learn more about the findings and what primary care physicians should tell older adult patients about potential adverse events with their new medications.

Healio: What are the key takeaways of the findings?

Tarn: Our key finding was that if doctors do not specifically convey information about a medication’s side effects, patients may not realize that a newly prescribed medication has potential side effects. We also found that patients were pretty good about ascertaining the directions for taking a new prescription, even without physician counseling.

Healio: What are the most common medications in older adults, and why is it essential that patients understand their adverse events?

Tarn: In this study we did not examine the medications that the physicians prescribed. It is essential for patients to understand that all medications have potential side effects before leaving a doctor’s visit, though. If they discover unexpected potential side effects after they leave the office, they may be scared to start a new medication, and may be unable to reach their prescriber in a timely manner to ask questions about the side effects.

Healio: Based on the findings, how should PCPs change their approach to discussing new medications with older adult patients?

Tarn: When prescribing a new medication, PCPs could consider focusing their limited time on conveying and answering questions about potential side effects, rather than on discussions about directions for use, which patients can more easily obtain from written information provided after the visit.

Healio: What is the best way for physicians to discuss potential adverse events of new medications with their patients?

Tarn: Rather than going through a comprehensive list of potential adverse events — which is unrealistic to do during office visits — physicians could consider mentioning the most common and most dangerous adverse events, and orienting patients to how often these might be expected to happen, and what to do if they occur.

Healio: What additional research is needed to evaluate older adult patients’ understanding of medication adverse events?

Tarn: Additional research is needed to determine how different strategies for counseling patients about medication adverse events contributes to patient understanding about adverse events, but more importantly, to patient medication adherence.

References:

Ho T, et al. J Gen Intern Med. 2021;doi:10.1007/s11606-020-06540-4.

Healio Interview