All these drugs are commonly prescribed to older adults, and they can be hard to use correctly. ... Some require blood testing to adjust their doses, and a small dose can have a powerful effect. Blood sugar can be notoriously hard to control in people with diabetes, for example, and taking a slightly larger dose of insulin than needed can send a person into shock.
The most significant finding of this study was [that] of the thousands of medicines available to older adults, it's really a small group ... that causes two-thirds of the hospitalizations," he tells WebMD.
The blood thinner warfarin, insulin, oral anti-platelets such as aspirin, and oral diabetes drugs led the list.
"Both blood thinners and diabetes medicines are critical drugs that can be lifesaving," Budnitz says. However, he says that ''these are medications that you do need to pay attention to," being sure the dose and timing are correct, among other measures.
High-risk medications, such as narcotics, only accounted for about 1% of the hospitalizations, the researchers found.
The study is published in The New England Journal of Medicine.
Tracking Bad Events From Drugs
The researchers used data collected between 2007 and 2009 from 58 hospitals around the country. The facilities participate in the CDC's drug event surveillance project.
The researchers looked at how often an adult 65 or older was hospitalized after emergency department visits for adverse drug events.
The researchers estimated that 265,802 visits to emergency departments for adverse drug events occurred from 2007 to 2009 for adults 65 or older.
Over a third of these visits, or nearly 100,000, required hospitalization. About half of the patients hospitalized were age 80 or older.
Unintentional overdose of medication was the most common reason, accounting for nearly two-thirds of hospitalizations.
When Budnitz's team looked at the medicines most likely to cause problems, they found:
33%, or 33,171 hospitalizations, involved warfarin, a blood thinner used to prevent clots.
14%, or 13,854 hospitalizations, involved insulin.
13%, or 13,263 hospitalizations, involved oral anti-platelet drugs, such as aspirin.
11%, or 10,656 hospitalizations, involved oral diabetes drugs.
These are often critical medicines for patients' health," he said. "Patients who are on these medicines should tell all their doctors what they are taking and work together with their doctors and pharmacist to make sure that they are taking these medicines correctly."
Among U.S. adults aged 65 and up, 40 percent take five to nine medications and 18 percent take 10 or more, according to the study authors. Prior research has also found that older adults are nearly seven times more likely than younger people to have an adverse drug event that requires hospitalization. "As most people age, there often are changes in how their kidneys, liver, heart, and other organs work that can make them more susceptible to adverse drug events," Budnitz said.
And though taking lots of pills raises safety issues, in 82 percent of cases the treating physician attributed the overdose to a single drug, Budnitz added.
To reduce risks, Steinman said doctors and patients need to discuss whether the drug is truly necessary. For people with very high blood pressure or blood sugar, "the answer is almost always 'yes,' you should treat it," Steinman said. "But if you have only mildly elevated blood pressure or blood sugar, the benefits of treating it versus the harms start to shift. Do these drugs really provide enough benefit that it's worth taking them?"
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