Diabetes drugs and blood thinners cause two-thirds of the 99,628 US senior hospitalizations each year because of drug adverse events, researchers from the CDC reported in NEJM (New England Journal of Medicine). The authors added that hundreds of millions of dollars could be saved if focus were placed on education and drug management of patients with certain long-term (chronic) diseases and conditions.

This article comes as the US government aims to bring down the number of repeat hospitalizations by one fifth by the end of 2013.

Dan Budnitz, M.D., M.P.H., director of CDC’s Medicaton Safety Program 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. 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.”

Budnitz and team gathered information from 58 hospitals around the country between 2007 and 2009. They said their data came from a nationally representative sample; patients involved in the CDC’s National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project. Their study did not include emergency hospital visits cause by drug abuse, withdrawal or deliberate self-harm.

48.1% of hospital admittances occurred among patients aged at least 80 years. 65.7% were caused by drug overdoses, or unexpected reactions to medications which were taken according to instructions.

Four medications, used either on their own or in combination, cause two-thirds of emergency hospitalizations:

  • Warfarin – caused 33% (33.171) of hospitalizations. Warfarin is a blood thinner – it prevents the formation of blood clots. When not monitored properly it can lead to hemorrhaging. The authors believe the cost of warfarin-cause hospitalizations is in the hundreds of millions of dollars annually.
  • Insulin injections – caused 14% of emergency hospitalizations. Insulin injections are used for blood sugar control in patients with diabetes.
  • Antiplatelet drugs – caused 13% of emergency hospitalization. Examples include aspirin and clopidogrel. These drugs also help prevent the formation of blood clots (prevent platelet formation)
  • Oral hypoglycemic agents (oral diabetes drugs) – caused 11% of emergency hospitalizations.

The authors say that national monitoring of adverse drug events of newly approved medications is vital, especially those that become popular.

The researchers noted that drugs which are currently viewed as high risk for hospitalizations, such as painkillers (acetaminophen), were not causing a very high number of hospitalizations of seniors.

Chief medical officer of the Centers for Medicare & Medicaid Services, Patrick Conway, M.D., M.Sc., said:

“Policies and improvement programs to promote safe use of medications that most commonly cause serious, measurable harms can increase patient safety and reduce unnecessary hospitalizations and costs at the same time.

We are working across the federal government to address common preventable adverse drug events through medication management, care transition programs, and other initiatives.”

An elderly person is seven times more likely to be admitted to hospital for an adverse drug event than a younger individual, the authors explained.

Americans are living longer, this means that seniors will represent a higher percentage of the country’s population, which also means there will be even more adverse drug events. 12.8% of the US population was aged at least 65 years in 2010, a total of 16,901,232 senior males and 22,571,696 senior females.

Approximately 40% of seniors take between five and nine medications, while 18% are on at least ten drugs, the authors found.

The researchers say that there should be closer liaison between hospitals and primary-care doctors (general practitioners), to make sure that drug use is monitored properly – this would significantly reduce emergency hospitalization numbers. Budnitz said that pharmacists should also become more closely involved.

In an Abstract in the same journal, the authors concluded:

“Improved management of antithrombotic and antidiabetic drugs has the potential to reduce hospitalizations for adverse drug events in older adults.”

Written by Christian Nordqvist