Inappropriate Medication Administration to the Acutely Ill Elderly: A Nationwide Emergency Department Study

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Hi All,

 

See this: " Inappropriate medications were administered in an

estimated 16.1 million (12.6%) of elderly ED visits from 1992 to

2000 " .

 

And FDA blocks herbal Medicine at every misuse of OTC herbs!

 

Best regards,

Phil

 

Jeffrey M. Caterino, MD; Jennifer A. Emond, MS; Carlos A.

Camargo, Jr, MD, DrPH (2004) Inappropriate Medication

Administration to the Acutely Ill Elderly: A Nationwide Emergency

Department Study, 1992-2000, Posted 11/19/2004. Journal of the

American Geriatrics Society 52 (11). Abstract: Objectives: To

determine the national rate and trend of inappropriate medication

administration to elderly emergency department (ED) patients.

Secondary objectives were to identify risk factors for receiving an

inappropriate medication and to determine whether administration

is sometimes justified based on diagnosis. Design: Retrospective

analysis of ED visits in the 1992–2000 National Hospital

Ambulatory Medical Care Survey. Inappropriate medications

identified using Beers' 1997 explicit criteria. Setting: EDs of U.S.

noninstitutionalized general and short-stay hospitals. Participants:

ED survey patients aged 65 and older. Measurements: Magnitude

and rate of administration of 36 medications. Results: Inappropriate

medications were administered in an estimated 16.1 million (95%

confidence interval (CI)=14.9–17.3 million) or 12.6% (95%

CI=11.6–13.5%) of elderly ED visits from 1992 to 2000. The rate of

inappropriate administration was unchanged throughout the study

period (P=.40). Six drugs accounted for 70.8% of inappropriate

administration: promethazine (22.2%), meperidine (18.0%),

propoxyphene (17.2%), hydroxyzine (10.3%), diphenhydramine

(7.1%), and diazepam (6.0%). In multivariate analysis, number of

ED medications was the strongest predictor, with an odds ratio for

two to three medications of 6.0 (95% CI=5.3–6.7) and for four to six

medications of 8.1 (95% CI=7.2–9.2). Diagnoses indicating

potentially appropriate uses of these medications were rarely

present. For example, only 42.4% of patients receiving

diphenhydramine and 7.4% receiving hydroxyzine were diagnosed

with an allergic process. Conclusion: Elderly ED patients are

frequently administered inappropriate medications. Potentially

appropriate uses of generally inappropriate drugs cannot account

for such administrations. Inappropriate administration rates remain

unchanged despite the 1997 publication of explicit criteria.

 

For the full text, see

http://www.medscape.com/viewpublication/1010

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