3869 Framework-guided domain mapping of adverse drug events in older adults: a scoping review of intersectional risks

Abstract Introduction Adverse drug events (ADEs) in older adults contribute to preventable harm, hospitalisation, and health inequalities. While age-related physiological changes affecting drug safety are recognised, less attention is paid to how sociodemographic and structural factors such as ethnicity and deprivation jointly shape vulnerability to ADEs. This limits the ability to design equitable medication safety strategies. This review examines how intersectional risks are currently conceptualised and analysed in ADE research, to inform more inclusive approaches to medication safety. Method We conducted a scoping review using JBI guidance and reported using PRISMA-ScR. Six databases were searched for peer-reviewed studies (2001–2024) on community-dwelling adults aged ≥65 years, examining ADEs and analysing at least two sociodemographic or health-related variables. A composite framework was developed using the National Institute on Ageing Health Disparities Framework, National Institute on Minority Health and Health Disparities Framework, and Dahlgren & Whitehead model. This mapped five domains of influence: biological, behavioural, sociocultural, environmental, and healthcare system. Results From 7900 studies, 47 met the inclusion criteria. All considered biological factors, but few examined behavioural (17.0%), sociocultural (19.1%), environmental (31.9%), or healthcare system (25.5%) domains. Only eleven tested interaction effects or conducted subgroup analyses. None employed advanced intersectionality-aligned approaches such as Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) or latent class analysis. Sociodemographic factors were often simplified (e.g. binary ethnicity) and primarily treated as confounders rather than explanatory variables. Methodological quality was moderate to high, but reporting on equity-relevant variables was inconsistent. Conclusions Current ADE research inadequately captures the complexity of intersectional risks in older adults. By identifying this critical gap and offering a clear framework for equity-informed analyses, these findings can help promote a shift towards more personalised, inclusive, and system-aware medication safety. This could improve outcomes particularly for older adults experiencing multiple, intersecting disadvantages.