1 in 6 Older ER Patients Wrongly Given Potentially Harmful Drugs

by Tony Isaacs

A recent study at the University of Michigan has found that over 1 in 6 older patients receive the wrong medications in emergency room visits. According to the study, which was published in Academic Emergency Medicine, nearly 19.5 million patients age 65 and older received one or more potentially inappropriate medications (PIMs) in emergency visits from 2000-2006.

According to researchers, doctors are not aware of the right drugs and dosages to give to older patients. As a result, the risks involved outweigh any benefits of the drugs. The problem may be even worse than the study suggests, say the researchers. The researchers also noted that since the study did not explore the possibility of medication interactions, it is possible that the potential harm by medications is even greater than their study suggests.

Certain pain relievers and antihistamines are among most common drugs used in emergency visits, in spite of known risks to those over age 65. The study found that 10 medications accounted for 86.5 percent of PIMs used in emergency room treatment. The five most common ones used were promethazine, ketorolac, propoxyphene, meperidine, and diphenhydramine. Promethazine and ketorolac accounted for nearly 40% of the total.

"There are certain medications that probably are not good to give to older adults because the potential benefits are outweighed by potential problems," said lead author, William J. Meurer, assistant professor at the U-M Departments of Emergency Medicine and Neurology.

In the study, researchers looked at a large nationwide sample of approximately 470,000 emergency department and outpatient clinic visits. The study used data from the National Hospital Ambulatory Medical Care Survey, to see how many patients aged 65 and older were prescribed potentially inappropriate medications. The results of the study were then applied to the national estimate of about 1.5 billion total visits to estimate the total number of patients who received potentially inappropriate drugs.

There were substantial variations found between different regions as well as hospital type (teaching vs. non-teaching). PIMs were less likely to occur in emergency room visits to hospitals in the Northeast and twice as likely in the rest of the country. Receiving a potentially inappropriate medication was more likely to occur at for-profit hospitals.

Meurer suggested that greater efforts are needed to educate doctors about the suitability of medications for older patients. As published at the University of Michigan newsroom, Meurer offered the following advice to patients to help insure they do not receive inappropriate medications:

•Make sure you talk to your primary care physician, either during or after your ED visit.
•Know what medications and supplements you are taking and make sure the nurses and doctors at the ED know.
•Talk to the ED doctors and nurses about how long the medicines they have given you will affect you.
•Ask for a list of all medications that you received while at the ED before you leave the ED for home or to go to a bed in the hospital. The list should include information on the possible side effects of those medicines.
•If you leave the ED and then have an adverse event caused by medication, contact your physician immediately or go back to the emergency department.
•Be proactive with your pharmacy and make sure you understand what you are taking.

To read the full report of the study:

http://www3.interscience.wiley.com/cgi-bin/fulltext/123305845/PDFSTART?CRETRY=1&SRETRY=0

Sources included:

http://www.wddty.com/17-per-cent-of-the-over-65s-given-the-wrong-drug.html
http://www.sciencedaily.com/releases/2010/03/100312134943.htm
http://www2.med.umich.edu/prmc/media/newsroom/details.cfm?ID=1520