Emergency Hospitalizations for Adverse Drug Events in Older Americans

Daniel S. Budnitz, M.D., M.P.H., Maribeth C. Lovegrove, M.P.H., Nadine Shehab, Pharm.D., M.P.H., and Chesley L. Richards, M.D., M.P.H.

Adverse drug events are important preventable causes of hospitalization in older adults. However, nationally representative data on adverse drug events that result in hospitalization in this population have been limited.

METHODS

We used adverse-event data from the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project (2007 through 2009) to estimate the frequency and rates of hospitalization after emergency department visits for adverse drug events in older adults and to assess the contribution of specific medications, including those identified as high-risk or potentially inappropriate by national quality measures.

RESULTS

On the basis of 5077 cases identified in our sample, there were an estimated 99,628 emergency hospitalizations (95% confidence interval [CI], 55,531 to 143,724) for adverse drug events in U.S. adults 65 years of age or older each year from 2007 through 2009. Nearly half of these hospitalizations were among adults 80 years of age or older (48.1%; 95% CI, 44.6 to 51.6). Nearly two thirds of hospitalizations were due to unintentional overdoses (65.7%; 95% CI, 60.1 to 71.3). Four medications or medication classes were implicated alone or in combination in 67.0% (95% CI, 60.0 to 74.1) of hospitalizations: warfarin (33.3%), insulins (13.9%), oral antiplatelet agents (13.3%), and oral hypoglycemic agents (10.7%). High-risk medications were implicated in only 1.2% (95% CI, 0.7 to 1.7) of hospitalizations.

CONCLUSIONS

Most emergency hospitalizations for recognized adverse drug events in older adults resulted from a few commonly used medications, and relatively few resulted from medications typically designated as high-risk or inappropriate. Improved management of antithrombotic and antidiabetic drugs has the potential to reduce hospitalizations for adverse drug events in older adults.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.

We thank Kelly Weidenbach, M.P.H., and Victor Johnson of Northrop Grumman (contractors for the Centers for Disease Control and Prevention) and Cathy Irish, B.S., and Joel Friedman, B.A., of the U.S. Consumer Product Safety Commission for assistance with data collection and processing.

SOURCE INFORMATION

From the Division of Healthcare Quality Promotion (D.S.B., M.C.L., N.S.), the Office of Prevention through Healthcare (C.L.R.), Centers for Disease Control and Prevention, and the Division of Geriatrics and Gerontology, Emory University School of Medicine (C.L.R.) — all in Atlanta.

Address reprint requests to Dr. Budnitz at the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, 1600 Clifton Rd., NE, Mailstop A-24, Atlanta, GA 30333, or at dbudnitz@cdc.gov.