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Prevalence of Unplanned Hospitalizations Caused by Adverse Drug Reactions in Older Veterans
Author(s) -
Marcum Zachary A.,
Amuan Megan E.,
Hanlon Joseph T.,
Aspinall Sherrie L.,
Handler Steven M.,
Ruby Christine M.,
Pugh Mary Jo V.
Publication year - 2012
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2011.03772.x
Subject(s) - medicine , polypharmacy , veterans affairs , odds ratio , emergency medicine , confidence interval , retrospective cohort study , logistic regression , population , environmental health
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.