4 Drugs Cause Most Hospitalizations in Seniors

Blood thinners and diabetes medications top the list of drugs that send seniors to emergency departments, researchers reported.

Adverse drug events (ADEs) send nearly 100,000 seniors to emergency departments (ED) each year, and two-thirds of those hospitalizations are attributed to just a few antithrombotic and antidiabetic drugs, according to a new study by the Centers for Disease Control and Prevention (CDC).

Warfarin, insulin, antiplatelets, and oral hypoglycemic agents are implicated alone or in combination in 71% of drug-related ED visits by older adults, CDC researchers reported last week in the New England Journal of Medicine. These common yet complex drugs require ongoing management by pharmacists and physicians to minimize their risks, according to senior author Dan Budnitz, MD, MPH.

“Blood thinners and diabetes medicines often require blood testing and dosing changes, but these are critical medicines for older adults,” Dr. Budnitz said in a press release. “Doctors and patients should continue to use these medications but remember to work together to safely manage them.” They’re also far more likely than so-called “red-flag” medications, such as painkillers, to land seniors in the hospital. In their study of hospitalizations in adults aged 65 and older, Dr. Budnitz and colleagues found that:

• 33% involved the anticoagulant warfarin
• 14% involved insulin injections
• 13% involved antiplatelets, such as aspirin or clopidogrel
• 11% involved oral hypoglycemic agents

By contrast, drugs identified by national quality measures as high-risk or potentially inappropriate for older patients caused just 1.2% and fewer than 6.6% of emergency hospitalizations, respectively.

The findings call for national policies and programs to prevent adverse events through better medication management, according to Dr. Budnitz, who also serves as director of the CDC’s Medication Safety Program. “These data suggest that focusing safety initiatives on a few medicines that commonly cause serious, measurable harms can improve care for many older Americans,” he said.

Safety tips for seniors

The study’s main takeaway for seniors is that they need to be engaged in their care, Dr. Budnitz said in a New York Times interview. Seniors are more likely to take multiple medications. They are also twice as likely as others to need emergency care following an adverse drug event, and nearly 7 times more likely to be hospitalized after an emergency visit, according to the CDC. To lower their risk, the CDC’s Medication Safety Program advises older adults to:

• Keep a list of their medicines
• Follow directions
• Ask questions
• Keep up with recommended blood testing
• Take pain relievers and antibiotics only as directed

These simple steps become more important as patients age and their medication regimen grows. In the recent study, 48.1% of hospitalizations occurred among adults aged 80 years and older. More than half (65.7%) were due to overdoses, or situations in which the correct dose was taken, but the drug’s effect on an individual patient was stronger than intended.

Ongoing communication between patients and the health care team adds a layer of protection, Dr. Budnitz told the Times. “I think the bottom line for patients is that they should tell all their doctors that they’re on these medications, and they should work with their physicians and pharmacies to make sure they get appropriate testing and are taking the appropriate doses.”

For other articles in this issue, see:

• The Pitfalls of e-Prescribing
• Polypharmacy Linked to Erectile Dysfunction