Geriatric ED patients often get potentially inappropriate drugs

One in six elderly patients who visit an emergency department receives a potentially inappropriate medication, according to a national study in United States. That adds up to an estimated 2.7 million geriatric patients each year who get one or more medications with unfavorable risk-benefit ratios because of age-related changes in pharmacodynamics, Dr. William J. Meurer reported at the annual meeting of the Society for Academic Emergency Medicine.
If the geriatric patient was prescribed two or more medications during the ED visit, the odds that at least one of them would be potentially inappropriate jumped sevenfold, compared with that of recipients of a single medication, according to Dr. Meurer of the University of Michigan, Ann Arbor.
In a multivariate logistic regression analysis, another strong predictor of receiving a potentially inappropriate medication was geographic location: Elderly patients who visited an ED in any part of the country other than the Northeast were at twofold greater risk. The other significant predictors were being a woman, which was associated with a 1.49-fold increased risk; being age 65-74 years, with a 1.48-fold greater risk than in patients aged 75 years and up; and being seen only by an attending emergency physician without resident involvement, which conferred a 1.19-fold increased risk.
He presented an analysis of National Hospital Ambulatory Medical Care Survey data for the years 2000-2006. The data set provided a weighted estimate encompassing 116 million ED visits by elderly individuals who were ultimately discharged home. About 80% of the ED visits entailed no resident involvement. At least one drug on the updated Beers Criteria of potentially inappropriate medications in the elderly was prescribed in 16.8% of visits (Arch. Intern. Med. 2003;163:2716-24). The absolute risk was 1% lower in 2005-2006 than in 2000-2004, a significant difference because of the large numbers involved.
The study was funded by the National Institute on Aging. Dr. Meurer reported no financial conflicts of interest.