Four medications send elderly to the hospital most often, study says

Most emergency hospitalizations of older Americans were the result of harm from a few blood thinners and diabetes medications, according to an analysis by the Centers for Disease Control and Prevention.

Improving the management of those types of drugs could reduce hospitalizations for adverse events and reduce healthcare costs, according to the study, published in the November New England Journal of Medicine. It said there are about 100,000 emergency hospitalizations of those 65 years or older each year. Two-thirds of the hospitalizations stemmed from use either separately or in combination of warfarin, insulin, antiplatelet drugs or oral medications used to treat diabetes.

Warfarin, or Coumadin, is a blood thinner that's used to prevent blood clots. It was responsible for one-third of the hospitalizations. Another 14 percent involved insulin, an injectable that is used to control blood sugar in people with diabetes. Antiplatelet drugs including clopidogrel and aspirin led to 13 percent of the hospitalizations, while the oral hypoglycemic agents were the cause 11 percent of the time.

"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 Dr. Dan Budnitz, director of the CDC's Medication Safety Program, in a written statement.

Each of the drugs identified has a thin margin between an effective dose and a potentially dangerous one, which is called a narrow therapeutic index.

For the study, researchers used 2007 to 2009 adverse-event data collected from 58 hospitals for the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event project to estimate how often older patients who came into the emergency room for adverse effects of medications were hospitalized and what the contributing medications were.

About half the hospitalizations were of adults 80 and older. Nearly two-thirds were because of accidental overdoses.

The researchers emphasized that "relatively few resulted from medications typically designated as high-risk or inappropriate" for older patients. Preventing adverse drug events is an important way to conserve limited healthcare dollars.

A government initiative called the Partnership for Patients noted that those 65 and older are seven times as apt as younger people to have adverse drug events that land them in the hospital. Senior are also more likely to be hospitalized because they have greater numbers of chronic conditions and take more medicines.

The partnership is a collaboration, it says, between "major hospitals, employers, physicians, nurses and patient advocates along with state and federal governments in a shared effort to make hospital care safer, more reliable and less costly."

Budnitz told the New York Times' Tara Parker-Pope that researchers were not surprised by the drugs that were identified as commonly behind emergency hospitalizations in older adults. "But we were surprised how many of the emergency hospitalizations were due to such a relatively small number of these drugs."

Parker-Pope noted that 40 percent of people 65 and older take between five and nine medications.

EMAIL: lois@desnews.com, Twitter: Loisco