Seniors Often Get Inappropriate Drugs in ED, Says Study

It is common for patients 65 and older to get potentially inappropriate medications when treated in emergency departments, a new University of Michigan Health System study has found.

Nearly 19.5 million older patients, or 16.8% of eligible emergency visits from 2000-2006, received one or more potentially inappropriate medications—or PIMs. The large sample of approximately 470,000 ED and outpatient clinic visits, corresponding to a national estimate of about 1.5 billion total visits, allowed the researchers to determine the extent of the problem nationwide, according to the study published in Academic Emergency Medicine.

Researchers looked at a nationwide sample of ED visits using data from the National Hospital Ambulatory Medical Care Survey to see how many patients aged 65 and older sent home from the ED were prescribed potentially inappropriate medications. The study found that 10 medications accounted for 86.5% of PIMs in the ED.

The five most common ones were promethazine, ketorolac, propoxyphene, meperidine, and diphenhydramine; and two of these—promethazine and ketorolac—accounted for nearly 40% of PIMs.

William J. Meurer, MD, the lead author of the study, and an assistant professor at U-M’s departments of Emergency Medicine and Neurology, said doctors need more education about the suitability of certain medications for older adults. The study also found that prescribing inappropriate medications was less likely to occur if a resident or intern was involved in the treatment, probably because younger doctors have had recent training about medications.

There was substantial regional and hospital type (teaching vs. non-teaching) variability. PIMs were less likely to occur in visits to hospitals in the Northeast and twice as likely in other parts of the country. And receiving a potentially inappropriate medication was more likely to occur at for-profit hospitals.

The study did not explore the possibility of medication interactions, so it is possible that the potential harm by medications is underestimated.