Medication Use Leading to Emergency Department Visits for Adverse Drug Events in Older Adults

4 December 2007 | Volume 147 Issue 11 | Pages 755-765

Background: The Beers criteria identify inappropriate use of medications in older adults. The number of and risk for adverse events from these medications are unknown.

Objective: To estimate the number of and risk for emergency department visits for adverse events involving Beers criteria medications compared with other medications.

Design: Nationally representative, public health surveillance of adverse drug events and a cross-sectional survey of outpatient medical visits.

Setting: National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance System, 2004–2005; National Ambulatory Medical Care Survey, 2004; and National Hospital Ambulatory Medical Care Survey, 2004.

Participants: Persons 65 years of age or older seeking emergency department and outpatient care.

Measurements: Estimated number of and risks for emergency department visits for adverse drug events involving Beers criteria medications and other medications.

Results: Among U.S. patients 65 years of age or older, an estimated 177 504 emergency department visits (95% CI, 100 155 to 254 854 visits) for adverse drug events occurred both years. An estimated 3.6% (CI, 2.8% to 4.5%) of these visits were for adverse events medications considered to be always potentially inappropriate, according to the Beers criteria, and 33.3% (CI, 27.8% to 38.7%) of visits were for adverse events from 3 other medications (warfarin [17.3%], insulin [13.0%], and digoxin [3.2%]). Accounting for outpatient prescription frequency, the risk for emergency department visits for adverse events due to these 3 medications was 35 times (CI, 9.6 to 61) greater than that for medications considered to be always potentially inappropriate.

Limitation: Adverse events were identified only in emergency departments.

Conclusion: Compared with other medications, Beers criteria medications caused low numbers of and few risks for emergency department visits for adverse events. Performance measures and interventions targeting warfarin, insulin, and digoxin use could prevent more emergency department visits for adverse events.

Editors' Notes Context Emergency department visits by older adults are often due to adverse drug events, but the proportion of these visits that are the result of drugs designated as inappropriate for use in this population is unknown. Contribution Analyses of a national surveillance study of adverse drug events and a national outpatient survey estimate that Americans age 65 years or older have more than 175 000 emergency department visits for adverse drug events yearly. Three commonly prescribed drugs accounted for more than one third of visits: warfarin, insulin, and digoxin. Caution The study was limited to adverse events in the emergency department. Implication Strategies to decrease adverse drug events among older adults should focus on warfarin, insulin, and digoxin. —The Editors

 

Author and Article Information

From the Centers for Disease Control and Prevention, Atlanta, Georgia.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the funding agencies.

Acknowledgment: The authors thank Margie Goulding, PhD, of CDC, for insights in study design; Benjamin Kupronis, MPH, and Katherine Ellingson, PhD, of CDC, for programming assistance; Kelly Weidenbach, MPH, of CDC, and Cathy Irish, BS, and Joel Friedman, BA, of the U.S. Consumer Product Safety Commission, for assistance with data collection; and Daniel Pollock, MD, and Lee Annest, PhD, of CDC, for thoughtful review of the manuscript. No individuals named herein received compensation for their contributions.

Grant Support: This work was implemented using CDC funding and was supported in part by an appointment to the CDC Research Participation Program administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the U.S. Department of Energy and CDC (Dr. Shehab).

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Daniel S. Budnitz, MD, MPH, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop A-24, Atlanta, GA 30333; e-mail, dbudnitz{at}cdc.gov.

Current Author Addresses: Drs. Budnitz, Shehab, and Richards: Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop A-24, Atlanta, GA 30333.

Dr. Kegler: Coordinating Center for Environmental Health and Injury Prevention, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mailstop E-19, Atlanta, GA 30341.

Author Contributions: Conception and design: D.S. Budnitz, C.L. Richards.

Analysis and interpretation of the data: D.S. Budnitz, N. Shehab, S.R. Kegler, C.L. Richards.

Drafting of the article: D.S. Budnitz, N. Shehab, C.L. Richards.

Critical revision of the article for important intellectual content: D.S. Budnitz, N. Shehab, S.R. Kegler.

Final approval of the article: D.S. Budnitz, N. Shehab, S.R. Kegler.

Provision of study materials or patients: D.S. Budnitz, N. Shehab.

Statistical expertise: D.S. Budnitz, S.R. Kegler.

Obtaining of funding: D.S. Budnitz.

Administrative, technical, or logistic support: D.S. Budnitz, N. Shehab.

Collection and assembly of data: D.S. Budnitz, N. Shehab.

Read all Rapid Responses

Adverse Drug Events in the Elderly - Time to reiterate “Primum Non Nocere”

Mahesh Krishnamurthy, et al.

Annals Online, 4 Dec 2007 [Full text]

Doubts About the Conclusions of This Study

Adam G. Golden, et al.

Annals Online, 11 Dec 2007 [Full text]

Beers List Not a Patient-Centered Approach

Sam F Carter

Annals Online, 26 Dec 2007 [Full text]

Re: Doubts About Conclusions of This Study and Time to Reiterate "Primum Non Nocere"

Daniel S. Budnitz, et al.

Annals Online, 3 Jan 2008 [Full text]

Potentially inappropriate medications and adverse drug events in older adults admitted to hospital

Paul Gallagher, et al.

Annals Online, 25 Feb 2008 [Full text]