Prevalence of unplanned hospitalizations caused by adverse drug reactions in older veterans
Journal of the American Geriatrics Society, 2012•Wiley Online Library
Objectives To describe the prevalence of unplanned hospitalizations caused by adverse
drug reactions (ADRs) in older veterans and to examine the association between this
outcome and polypharmacy after controlling for comorbidities and other patient
characteristics. Design Retrospective cohort. Setting Veterans Affairs Medical Centers.
Participants Six hundred seventy‐eight randomly selected unplanned hospitalizations of
older (aged≥ 65) veterans between October 1, 2003, and September 30, 2006 …
drug reactions (ADRs) in older veterans and to examine the association between this
outcome and polypharmacy after controlling for comorbidities and other patient
characteristics. Design Retrospective cohort. Setting Veterans Affairs Medical Centers.
Participants Six hundred seventy‐eight randomly selected unplanned hospitalizations of
older (aged≥ 65) veterans between October 1, 2003, and September 30, 2006 …
Objectives
To describe the prevalence of unplanned hospitalizations caused by adverse drug reactions (ADRs) in older veterans and to examine the association between this outcome and polypharmacy after controlling for comorbidities and other patient characteristics.
Design
Retrospective cohort.
Setting
Veterans Affairs Medical Centers.
Participants
Six hundred seventy‐eight randomly selected unplanned hospitalizations of older (aged ≥ 65) veterans between October 1, 2003, and September 30, 2006.
Measurements
Naranjo ADR algorithm, ADR preventability, and polypharmacy (0–4, 5–8, and ≥9 scheduled medications).
Results
Seventy ADRs involving 113 drugs were found in 68 (10%) hospitalizations of older veterans, of which 25 (36.8%) were preventable. Extrapolating to the population of more than 2.4 million older veterans receiving care during the study period, 8,000 hospitalizations may have been unnecessary. The most common ADRs that occurred were bradycardia (n = 6; beta‐blockers, digoxin), hypoglycemia (n = 6; sulfonylureas, insulin), falls (n = 6; antidepressants, angiotensin‐converting enzyme inhibitors), and mental status changes (n = 6; anticonvulsants, benzodiazepines). Overall, 44.8% of veterans took nine or more outpatient medications and 35.4% took five to eight. Using multivariable logistic regression and controlling for demographic, health‐status, and access‐to‐care variables, polypharmacy (≥9 and 5–8) was associated with greater risk of ADR‐related hospitalization (adjusted odds ratio (AOR) = 3.90, 95% confidence interval (CI) = 1.43–10.61 and AOR = 2.85, 95% CI = 1.03–7.85, respectively).
Conclusion
ADRs, determined using a validated causality algorithm, are a common cause of unplanned hospitalization in older veterans, are frequently preventable, and are associated with polypharmacy.
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