February 24, 2011 |
|
In 2008, an estimated 2,157,128 ED visits were made by patients for adverse reactions to pharmaceuticals or other types of medications. Older adults accounted for more than half (51.5 percent, or 1,111,686 visits) of all visits involving adverse reactions.
Among older adults, more than half of these visits (61.5 percent) were made by patients aged 65 or older (Table 1). Females accounted for 60.9 percent of the ED visits for adverse reactions to medications among older adults.
Demographic Characteristic |
Estimated Number of ED Visits |
Percentage of Visits |
---|---|---|
Total ED Visits for Adverse Reaction |
1,111,686 | 100.0% |
Aged 50 to 64 | 427,740 | 38.5% |
Aged 65 or Older | 683,946 | 61.5% |
Male* | 434,104 | 39.1% |
Female* | 677,360 | 60.9% |
*Any ED visit for which gender or age was unknown was excluded. Source: 2008 SAMHSA Drug Abuse Warning Network (DAWN). |
Of all ED visits involving adverse reactions among older adults, the majority involved pharmaceuticals only (98.9 percent), whereas a small percentage (1.1 percent) involved a combination of alcohol and pharmaceuticals. There were no differences by age group.
Nearly 8 in 10 visits (79.5 percent, or 873,975 visits) involved only one pharmaceutical, almost 1 in 7 visits (13.7 percent, or 151,009 visits) involved two pharmaceuticals, and less than 1 in 10 (6.8 percent, or 74,904 visits) involved three or more pharmaceuticals (Figure 1).
Number of Pharmaceuticals | Percent |
---|---|
One Pharmaceutical | 79.5% |
Two Pharmaceutical | 13.7% |
Three or More Pharmaceuticals | 6.8% |
Source: 2008 SAMHSA Drug Abuse Warning Network (DAWN). |
Central nervous system (CNS) drugs (e.g., pain relievers and drugs used to treat anxiety and insomnia) were involved in almost one fourth (24.3 percent) of ED visits for adverse drug reactions among older adults (Table 2). The most commonly involved CNS drugs most commonly involved in visits for adults aged 50 to 64 were narcotic pain relievers (9.7 percent). Less than 1 in 10 visits among adults aged 65 or older involved narcotic pain relievers (8.3 percent) and non-narcotic pain relievers (8.7 percent).
Drug Category | Percentage of Visits,* Patients Aged 50 or Older (N = 1,111,686) |
Percentage of Visits,* Patients Aged 50 to 64 (n = 427,740) |
Percentage of Visits,* Patients Aged 65 or Older (n = 683,946) |
---|---|---|---|
Central Nervous System Drugs | 24.3% | 25.2% | 23.8% |
Narcotic Pain Relievers | 8.9% | 9.7% | 8.3% |
Non-narcotic Pain Relievers | 7.7% | 6.0% | 8.7% |
Blood Modifiers | 17.6% | 9.6% | 22.6% |
Cardiovascular System Medications | 16.4% | 13.8% | 18.1% |
Anti-infection Medications | 15.1% | 16.9% | 14.1% |
Metabolic Disorder Drugs | 12.2% | 12.2% | 12.2% |
Cancer Drugs | 6.4% | 7.1% | 6.0% |
Psychotherapeutic Drugs | 5.0% | 6.8% | 3.9% |
* Because multiple drugs may be involved in each visit, percentages may add to more than 100 percent. Source: 2008 SAMHSA Drug Abuse Warning Network (DAWN). |
After CNS drugs, the medications most often involved in ED visits for adverse reactions varied by age group. For those aged 50 to 64, anti-infection medications were the second most commonly involved type of medications in these visits, followed by cardiovascular system medications and drugs for metabolic disorders. For those aged 65 or older, blood modifiers were the second most commonly involved type of medications, followed by cardiovascular system medications and anti-infection medications.
Nearly two thirds of older adults who visited the ED for adverse drug reactions were treated and released (64.2 percent, or 714,099 visits) and nearly one third were admitted to the hospital (32.9 percent, or 365,993 visits) (Figure 2). Considerable variation was noted between the two age groups, with patients aged 50 to 64 being admitted to the hospital at a lower percentage than those aged 65 or older (25.5 vs. 37.6 percent, respectively). Less than 4 percent of both age groups were admitted to the intensive care unit (3.5 percent for patients aged 50 to 64 and 3.4 percent for patients aged 65 or older).
Age Group | Treated and Released |
Admitted to the Hospital |
Other Disposition |
---|---|---|---|
Aged 50 or Older* | 64.2% | 32.9% | 2.8% |
Aged 50 to 64* | 71.7% | 25.5% | 2.8% |
Aged 65 or Older* | 59.6% | 37.6% | 2.9% |
*Percentages may not add to 100 percent because of rounding. Source: 2008 SAMHSA Drug Abuse Warning Network (DAWN). |
Of the older adults experiencing an adverse reaction that resulted in a hospital admission, more than 3 in 4 visits (76.9 percent, or 281,448 visits) involved one medication, less than 1 in 6 visits (14.5 percent, or 53,104 visits) involved two medications, and less than 1 in 10 visits (8.6 percent, or 31,440 visits) involved three or more medications. Blood modifiers (24.3 percent), CNS drugs (22.4 percent), and cardiovascular system medications (18.3 percent) were the drugs most commonly involved in visits that resulted in hospital admissions.
ED visits and hospital admissions related to adverse reactions among older adults are common and place a costly burden on health care services. The demand for such services will increase as the United States population ages, in general, and when the "baby boom" generation reaches older adulthood in particular. This report shows that the majority of visits involving adverse reactions among older adults involved only one pharmaceutical. Moreover, of the nearly one third (32.9 percent) of visits that resulted in a hospital admission among this population, 76.9 percent involved only one medication as well.
These findings underscore the critical importance for continued surveillance of adverse reactions to maintain drug safety. Enhancing drug safety is an important step toward increasing medical care quality and reducing health care costs overall. Although most adverse reactions involve a sungle drug, patients can help prevent drug-drug interactions by informing physicians, nurses, and mental health care providers of all medications, supplements, and vitamins they take and making sure that any medical records are shared with all physicians, including specialists. Patients can safeguard against adverse reactions by using one pharmacy to handle all their prescriptions and by advising their pharmacy of any adverse reactions to prescription or OTC medications.7
As parents age, family members and other care providers may have increasing responsibility to monitor the drugs taken by older adults. Caregivers need to be knowledgeable about the potential side effects of both prescription and over-the-counter medications and be aware of any past history of adverse reactions to particular pharmaceuticals and medications.
The Drug Abuse Warning Network (DAWN) is a public health surveillance system that monitors drug-related morbidity and mortality. DAWN uses a probability sample of hospitals to produce estimates of drug-related emergency department (ED) visits for the United States and selected metropolitan areas annually. DAWN also produces annual profiles of drug-related deaths reviewed by medical examiners or coroners in selected metropolitan areas and States. Any ED visit related to recent drug use is included in DAWN. All types of drugs—licit and illicit—are covered. Alcohol involvement is documented for patients of all ages if it occurs with another drug. Alcohol is considered an illicit drug for minors and is documented even if no other drug is involved. The classification of drugs used in DAWN is derived from the Multum Lexicon, copyright 2010 Lexi-Comp, Inc. and/or Cerner Multum, Inc. The Multum Licensing Agreement governing use of the Lexicon can be found at http://dawninfo.samhsa.gov/drug_vocab. DAWN is one of three major surveys conducted by the Substance Abuse and Mental Health Services Administration's Center for Behavioral Health Statistics and Quality (SAMHSA/CBHSQ). For more information on other CBHSQ surveys, go to http://oas.samhsa.gov. SAMHSA has contracts with Westat (Rockville, MD) and RTI International (Research Triangle Park, NC) to operate the DAWN system and produce publications. For publications and additional information about DAWN, go to http://DAWNinfo.samhsa.gov/. |
The DAWN Report is published periodically by the Center for Behavioral Health Statistics and Quality (formerly the Office of Applied Studies), Substance Abuse and Mental Health Services Administration (SAMHSA). All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Additional copies of this report or other reports from the Center for Behavioral Health Statistics and Quality are available online: http://oas.samhsa.gov/. Citation of the source is appreciated. For questions about this report, please e-mail: shortreports@samhsa.hhs.gov.
DAWN_013 |
This page was last updated on December 11, 2010. |
SAMHSA, an agency in the Department of Health and Human Services, is the Federal Government's lead agency for improving the quality and availability of substance abuse prevention, addiction treatment, and mental health services in the United States.
* PDF formatted files require that Adobe Acrobat ReaderĀ® program is installed on your computer. Click here to download this FREE software now from Adobe. |