An estimated 100,000 older Americans are hospitalized for adverse drug reactions yearly, and most of those emergencies stem from four common medications, a new study finds.
The four types of medication — two for diabetes and two blood-thinning agents — account for two-thirds of those drug-related emergency hospitalizations.
“Of the thousands of medications available to older patients, a small group of blood thinners and diabetes medications caused a high proportion of emergency hospitalizations for adverse drug events among elderly Americans,” said lead study author Dr. Daniel Budnitz, director of the U.S. Centers for Disease Control and Prevention’s medication safety program.
Medications previously designated “high-risk” were implicated in only 1.2 percent of hospitalizations, the study found.
Working with a nationally representative database, CDC researchers identified more than 5,000 cases of drug-related adverse events that occurred among people aged 65 and older from 2007 to 2009 and used that to make their estimates for the whole population.
Nearly half (48 percent) of the hospitalizations occurred among adults 80 and up, according to the study, published in the Nov. 24 issue of the New England Journal of Medicine. Nearly two-thirds (66 percent) were the result of unintentional overdoses.
The four medications, used alone or together, most often cited:
The blood thinning medication warfarin (Coumadin, Jantoven), which is used to treat blood clots, was involved in 33 percent of emergency hospitalizations.
Insulin, used to control blood sugar in diabetes patients, was involved in 14 percent of cases.
Antiplatelet drugs such as aspirin and clopidogrel (Plavix), which are used to prevent blood clots, were involved in 13 percent of cases.
The medications most often implicated were warfarin, insulins, oral antiplatelet agents, and oral hypoglycemic agents, which either alone or in combination accounted for 33%, 14%, 13%, and 11% of the hospitalizations, respectively, the investigators reported (N. Engl. J. Med. 2011;365:2002-12).
Emergency department visits resulting in hospitalization were more likely than those not resulting in hospitalization to involve unintentional overdoses (66% vs. 46%) and to involve at least five medications (55% vs. 40%).
The researchers noted that medications typically deemed high risk or inappropriate for elderly patients resulted in relatively few emergency hospitalizations, accounting for only about 1% and 7% of the 65-and-over emergency admissions, respectively.
The findings have important implications for reducing harm and health care costs among older adults, said Dr. Budnitz and his colleagues. Such detailed and drug-specific data can help focus current patient-safety efforts, such as the Partnership for Patients, they said. That $1 billion federal initiative has the goal of decreasing preventable hospitalizations 20% by the end of 2013.
The investigators used adverse-event data for 2007 through 2009 from the National Electronic Injury Surveillance System – Cooperative Adverse Drug Event Surveillance Project. They based their national estimates on an analysis of 5,077 emergency hospitalizations in older adults at 58 nonpediatric hospitals that participate in the surveillance system.
The numbers probably represent underestimates of emergency hospitalizations, the investigators said. They explained that some patient groups – such as those admitted for diagnostic evaluation or transferred from other hospitals – were not represented in the analysis.
"Our findings suggest that efforts to improve medication safety for older adults should focus on areas in which improvements are most likely to have sizable, clinically significant, and measurable effects, such as improving the management of antithrombotic and antidiabetic drugs," the investigators concluded.
In a press statement, Dr. Budnitz acknowledged that blood thinners and diabetes medications are critical medicines for many older adults. "Doctors and patients should continue to use them but remember to work together to safely manage them," he said.
Neither Dr. Budnitz nor any of the other investigators disclosed any conflict of interest.
The four types of medication — two for diabetes and two blood-thinning agents — account for two-thirds of those drug-related emergency hospitalizations.
“Of the thousands of medications available to older patients, a small group of blood thinners and diabetes medications caused a high proportion of emergency hospitalizations for adverse drug events among elderly Americans,” said lead study author Dr. Daniel Budnitz, director of the U.S. Centers for Disease Control and Prevention’s medication safety program.
Medications previously designated “high-risk” were implicated in only 1.2 percent of hospitalizations, the study found.
Working with a nationally representative database, CDC researchers identified more than 5,000 cases of drug-related adverse events that occurred among people aged 65 and older from 2007 to 2009 and used that to make their estimates for the whole population.
Nearly half (48 percent) of the hospitalizations occurred among adults 80 and up, according to the study, published in the Nov. 24 issue of the New England Journal of Medicine. Nearly two-thirds (66 percent) were the result of unintentional overdoses.
The four medications, used alone or together, most often cited:
The blood thinning medication warfarin (Coumadin, Jantoven), which is used to treat blood clots, was involved in 33 percent of emergency hospitalizations.
Insulin, used to control blood sugar in diabetes patients, was involved in 14 percent of cases.
Antiplatelet drugs such as aspirin and clopidogrel (Plavix), which are used to prevent blood clots, were involved in 13 percent of cases.
The medications most often implicated were warfarin, insulins, oral antiplatelet agents, and oral hypoglycemic agents, which either alone or in combination accounted for 33%, 14%, 13%, and 11% of the hospitalizations, respectively, the investigators reported (N. Engl. J. Med. 2011;365:2002-12).
Emergency department visits resulting in hospitalization were more likely than those not resulting in hospitalization to involve unintentional overdoses (66% vs. 46%) and to involve at least five medications (55% vs. 40%).
The researchers noted that medications typically deemed high risk or inappropriate for elderly patients resulted in relatively few emergency hospitalizations, accounting for only about 1% and 7% of the 65-and-over emergency admissions, respectively.
The findings have important implications for reducing harm and health care costs among older adults, said Dr. Budnitz and his colleagues. Such detailed and drug-specific data can help focus current patient-safety efforts, such as the Partnership for Patients, they said. That $1 billion federal initiative has the goal of decreasing preventable hospitalizations 20% by the end of 2013.
The investigators used adverse-event data for 2007 through 2009 from the National Electronic Injury Surveillance System – Cooperative Adverse Drug Event Surveillance Project. They based their national estimates on an analysis of 5,077 emergency hospitalizations in older adults at 58 nonpediatric hospitals that participate in the surveillance system.
The numbers probably represent underestimates of emergency hospitalizations, the investigators said. They explained that some patient groups – such as those admitted for diagnostic evaluation or transferred from other hospitals – were not represented in the analysis.
"Our findings suggest that efforts to improve medication safety for older adults should focus on areas in which improvements are most likely to have sizable, clinically significant, and measurable effects, such as improving the management of antithrombotic and antidiabetic drugs," the investigators concluded.
In a press statement, Dr. Budnitz acknowledged that blood thinners and diabetes medications are critical medicines for many older adults. "Doctors and patients should continue to use them but remember to work together to safely manage them," he said.
Neither Dr. Budnitz nor any of the other investigators disclosed any conflict of interest.
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