Journal of Gerontological Nursing

EDITORIAL 

Iatrogenesis in the Elderly

Kathleen C Buckwalter, PhD, RN, FAAN; Jacqueline M Stolley, MA, RN, C

Abstract

The focus of this issue is iatrogenic disorders in the elderly. Iatrogenic disorders are defined as "any condition in a patient resulting from a treatment by a physician or surgeon."1 This definition is usually generalized to include the treatment of all health-care practitioners and may also encompass nontreatment when treatment is indicated. Nursing-induced disorders result from unintentional or incorrect treatment.2

The elderly are particularly susceptible to the effects of iatrogenic and nursing-induced phenomena because of their increasing incidence of frailness and chronic disease, precarious homeostasis, changes in body composition and function, and widespread use of drugs. For example, in a study of 185 hospitalized patients over age 75, 38% developed hospital-acquired complications.3 Predictors of iatrogenesis were dependency in activities of daily living and admission to the psychiatric service. Another report on hospital admissions of elderly patients found that 193 of 500 patients suffered from iatrogenic disorders.4

Common causes of iatrogenesis are the misuse or overuse of drugs, prolonged immobilization, nosocomial infections, and malnutrition or dehydration due to preparation for diagnostic tests. Jahnigen, Hannon, and Laxson reported iatrogenic complications in 45% of elderly veterans, compared with a rate of 29% in persons under age 65.5 Schimmel6 and Reichel4 have reported similar findings. These data clearly point to the need for understanding the phenomenon of iatrogenesis and further nursing research devoted to reducing the unwanted effects of health-care treatment on the elderly.

The most commonly reported iatrogenic problems occurring in longterm care include immobilization, adverse drug reactions, falls, pressure ulcers, and nosocomial infections. Therefore, these nursigenic problems form the content of this issue: Mobily and Kelley explore immobility causes and treatment; Stolley, Buckwalter, Fjordbak, and Bush discuss drug iatrogenesis and implications; Ross reviews fall assessment and methods for prevention; Kelley and Mobily report causes, prevention and treatment of pressure sores; and Stolley and Buckwalter identify common nosocomial infections and their causes and treatment.

To complicate clinical and research efforts, these conditions often represent a vicious cycle, with one treatment or lack of treatment causing the other. For example, drug reactions can cause an increase in falls, resulting in immobilization. Immobilization in turn may cause an increase in infection rates, especially in the respiratory and urinary tracts. Gerontological nurses need to identify the causes of these disorders, and to develop and test nursing interventions as well as effective means of education that would reduce or eliminate the incidence of iatrogenic disorders. In addition, more health-care professionals must be educated in the care of the aged, including aspects of normal aging and age-related physiological changes, proper exercise and mobility, causes and prevention of infection, and appropriate drug use in the elderly.

Iatrogenic disease can take many forms. Rve areas of concern have been identified in this issue, but other topics could have been included: eg, incontinence, confusion, and malnutrition. The susceptibility of the elderly to iatrogenic disorders is alarming, but not as alarming as the ignorance of many of the health-care professionals to whom this population entrusts their health. Further education and research are essential to increase awareness of the health-care problems caused by treatment, but also to inform health-care professionals of the incidence and preventability of these disorders.…

The focus of this issue is iatrogenic disorders in the elderly. Iatrogenic disorders are defined as "any condition in a patient resulting from a treatment by a physician or surgeon."1 This definition is usually generalized to include the treatment of all health-care practitioners and may also encompass nontreatment when treatment is indicated. Nursing-induced disorders result from unintentional or incorrect treatment.2

The elderly are particularly susceptible to the effects of iatrogenic and nursing-induced phenomena because of their increasing incidence of frailness and chronic disease, precarious homeostasis, changes in body composition and function, and widespread use of drugs. For example, in a study of 185 hospitalized patients over age 75, 38% developed hospital-acquired complications.3 Predictors of iatrogenesis were dependency in activities of daily living and admission to the psychiatric service. Another report on hospital admissions of elderly patients found that 193 of 500 patients suffered from iatrogenic disorders.4

Common causes of iatrogenesis are the misuse or overuse of drugs, prolonged immobilization, nosocomial infections, and malnutrition or dehydration due to preparation for diagnostic tests. Jahnigen, Hannon, and Laxson reported iatrogenic complications in 45% of elderly veterans, compared with a rate of 29% in persons under age 65.5 Schimmel6 and Reichel4 have reported similar findings. These data clearly point to the need for understanding the phenomenon of iatrogenesis and further nursing research devoted to reducing the unwanted effects of health-care treatment on the elderly.

The most commonly reported iatrogenic problems occurring in longterm care include immobilization, adverse drug reactions, falls, pressure ulcers, and nosocomial infections. Therefore, these nursigenic problems form the content of this issue: Mobily and Kelley explore immobility causes and treatment; Stolley, Buckwalter, Fjordbak, and Bush discuss drug iatrogenesis and implications; Ross reviews fall assessment and methods for prevention; Kelley and Mobily report causes, prevention and treatment of pressure sores; and Stolley and Buckwalter identify common nosocomial infections and their causes and treatment.

To complicate clinical and research efforts, these conditions often represent a vicious cycle, with one treatment or lack of treatment causing the other. For example, drug reactions can cause an increase in falls, resulting in immobilization. Immobilization in turn may cause an increase in infection rates, especially in the respiratory and urinary tracts. Gerontological nurses need to identify the causes of these disorders, and to develop and test nursing interventions as well as effective means of education that would reduce or eliminate the incidence of iatrogenic disorders. In addition, more health-care professionals must be educated in the care of the aged, including aspects of normal aging and age-related physiological changes, proper exercise and mobility, causes and prevention of infection, and appropriate drug use in the elderly.

Iatrogenic disease can take many forms. Rve areas of concern have been identified in this issue, but other topics could have been included: eg, incontinence, confusion, and malnutrition. The susceptibility of the elderly to iatrogenic disorders is alarming, but not as alarming as the ignorance of many of the health-care professionals to whom this population entrusts their health. Further education and research are essential to increase awareness of the health-care problems caused by treatment, but also to inform health-care professionals of the incidence and preventability of these disorders.

REFERENCES

  • 1. Miller BF, Keane CB. Encyclopedia and Dictionary of Medicine, Nursing and Allied Health, 2nd ed. Philadelphia: WB Saunders; 1975.
  • 2. Miller MB. Iatrogenic and nursigenic effects of prolonged immobilization of the ill aged. J Am Geriatr Soc. 1975; 23:360-369.
  • 3. Becker PM, McVey LJ, Saltz CC, Feussner JR, Cohen HJ. Hospital-acquired complications in a randomized controlled clinical trial of a geriatric consultation team. JAMA. 1987; 257:2313-2317.
  • 4. Reichel W. Complications in die care of five hundred elderly hospitalized patients. J Am Geriatr Soc. 1965; 13:973-981.
  • 5. Jahnigen D, Hannon C, Laxson L. Iatrogenic disease in hospitalized elderly veterans. J Am Geriatr Soc. 1982; 30.387-390.
  • 6. Schimmel EM. The hazards of hospitalization. Ann Intern Med. 1965; 60: 100-1 10.

10.3928/0098-9134-19910901-03

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