Elderly at risk of hospitalizations from key medications

Promoting safe use of blood thinners and diabetes medications can protect patients

Each year, there are nearly 100,000 emergency hospitalizations for adverse drug events in U.S. adults aged 65 years or older, according to a Centers for Disease Control and Prevention study published today in the New England Journal of Medicine. Of the thousands of medications available to patients, a small group of blood thinners and diabetes medications caused two–thirds of the emergency hospitalizations, the report said.  

“These data suggest that focusing safety initiatives on a few medicines that commonly cause serious, measurable harms can improve care for many older Americans,” said Dan Budnitz, M.D., M.P.H., director of CDC′s Medication Safety Program. “Blood thinners and diabetes medicines often require blood testing and dosing changes, but these are critical medicines for older adults with certain medical conditions.  Doctors and patients should continue to use these medications but remember to work together to safely manage them.”

The study used data collected between 2007 and 2009 from a nationally representative sample of 58 hospitals participating in CDC′s National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project. Almost half (48.1 percent) of these hospitalizations occur among adults aged 80 years or older, and two–thirds (65.7 percent) of the hospitalizations were due to overdoses, or to situations in which patients may have taken the prescribed amount of medication but the drug had more than the intended effect on the patient′s body. 

Four medications, used alone or together, accounted for two–thirds of the emergency hospitalizations:

33 percent, or 33,171 emergency hospitalizations, involved warfarin, a medication used to prevent blood clots.

14 percent involved insulins.  Insulin injections are used to control blood sugar in people who have diabetes.

13 percent involved antiplatelet drugs, such as aspirin or clopidogrel, which prevent platelets, or pieces of blood cells from clumping together to start a clot.

11 percent involved diabetes medications that are taken by mouth, called oral hypoglycemic agents.

 

This study identified specific medication safety issues that provide the greatest opportunities for reducing patient harm and health care utilization today.  Continued national monitoring of adverse drug events will be important as new medications are approved and become more commonly used.

CDC scientists noted medications currently identified by national quality measures as being high–risk or potentially inappropriate for older patients were rarely identified as the cause of emergency hospitalizations (1.2 percent and fewer than 6.6 percent, respectively).  

“Policies and improvement programs to promote safe use of medications that most commonly cause serious, measureable harms can increase patient safety and reduce unnecessary hospitalizations and costs at the same time,” said Patrick Conway, M.D., M.Sc., chief medical officer of the Centers for Medicare & Medicaid Services and director of CMS′ Office of Clinical Standards and Quality. “We are working across the federal government to address common preventable adverse drug events through medication management, care transition programs, and other initiatives.”

One initiative, the Partnership for Patients, includes an effort to decrease the number of preventable rehospitalizations by 20 percent by the end of 2013.  Older adults are nearly seven times as likely as younger people to have adverse drug events that require hospitalization. Hospitalizations for adverse drug events have the potential to increase as Americans live longer, have greater numbers of chronic conditions, and take more medications. Decreasing adverse drug events, including those from blood thinners and diabetes medications, is a key area of focus for the Partnership for Patients.

For more information about what CDC is doing to protect older adults from adverse drug events, visit www.cdc.gov/medicationsafety.

CDC works 24/7 saving lives, protecting people from health threats, and saving money through prevention. Whether these threats are global or domestic, chronic or acute, curable or preventable, natural disaster or deliberate attack, CDC is the nation′s health protection agency.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES