Just a few drugs responsible for majority of emergency hospitalizations

By Dr. Ananya Mandal, MDNov 24 2011

Latest research shows that just a few drugs are responsible for a majority of the emergency hospitalizations for bad events related to medication use in older U.S. adults.

The report suggests that annually there are nearly 100,000 emergency hospitalizations for adverse drug events in adults 65 and older, explained researcher Daniel S. Budnitz, director of the CDC's Medication Safety Program. “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 list of culprit drugs include blood thinner warfarin, diabetes injection insulin, oral anti-platelets such as aspirin and oral diabetes drugs. “Both blood thinners and diabetes medicines are critical drugs that can be lifesaving,” Budnitz said.  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.

For the study by the Centers for Disease Control and Prevention the team used data collected between 2007 and 2009 from 58 hospitals around the nation. They scrutinized the data to see how often an adult 65 or older was hospitalized after emergency department visits for adverse drug events. Researchers sampled more than 5,000 cases of drug-related hospitalizations tracked by the National Electronic Injury Surveillance System.

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.

The results showed 33%, or 33,171 hospitalizations, involved warfarin, a blood thinner used to prevent clots. Further 14%, or 13,854 hospitalizations, involved insulin, 13%, or 13,263 hospitalizations, involved oral anti-platelet drugs, such as aspirin and 11%, or 10,656 hospitalizations, involved oral diabetes drugs.

According to experts this is not surprising. Michael Cohen, president of the Institute for Safe Medication Practices told WebMD, “Sixty five percent of the drugs they have listed at the top [of the list of most often involved] are the ones we are studying on our high-alert drug list.”

Cohen advises knowledge on the side effects of the drugs. Laws differ among states as to mandates about patient counseling by the pharmacist, Cohen says. For instance, he says, sometimes pharmacists are required to offer patients counseling about a new prescription.

“I think the bottom line for patients is that they should tell all their doctors that they’re on these medications,” Budnitz said, “and they should work with their physicians and pharmacies to make sure they get appropriate testing and are taking the appropriate doses.”