Prevalence of Unplanned Hospitalizations Caused by Adverse Drug Reactions in Older Veterans
Year: 2011
Type: article
Study design: Observational Study
Abstract: 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.
Institutions: Edith Nourse Rogers Memorial Veterans Hospital, University of Pittsburgh, Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Center for Healthcare Evaluation, Research, and Promotion, Veterans Health Administration, Edward Hines, Jr. VA Hospital, The University of Texas at San Antonio Health Science Center, South Texas Veterans Health Care System
Language: English
Subfield: Geriatrics and Gerontology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: G1860291919, Longitudinal Impact of Antihypertensive Polypharmacy on Geriatric Syndromes, Intervention to Reduce Dietary Sodium in Hemodialysis, IMPACT OF MEDICARE PART D ON RACIAL DISPARITIES IN DIABETES TREATMENT AND OUTCOME, Study of Women's Health Across the Nation (SWAN) V: Coordinating Center, VIRTUAL CONTINUITY AND ITS IMPACT ON COMPLEX HOSPITALIZED PATIENTS' CARE, Longitudinal Impact of Antihypertensive Polypharmacy on Geriatric Syndromes, Impact of statins and ACE inhibitors on outcomes for pneumonia and sepsis, Medicare Part D Cost-Sharing and Treatment of Mental Disorders Among Disabled Dua, G6207296027, THE UNIVERSITY OF PITTSBURGH'S COMPARATIVE EFFECTIVENESS RESEARCH SCHOLARS PROGRA, ENHANCING THE DETECTION AND MANAGEMENT OF ADVERSE DRUG EVENTS IN THE NURSING HOME, Racial Disparities in Older Adults: Impact of Medicare Part D, UPITT Program for Pharmaceutical Outcomes Research in Aging, Pittsburgh Older Americans Independence Center, Pitt Integrated Clinical and Geroscience Research Training Program
OpenAlex ID: W1990654536