New research looking into adverse effects from medication use found that anticoagulants (blood thinners) and diabetes drugs send a significant amount of adults ages 65 and older to the emergency room each year.
Younger adults, between the ages of 25 and 44, were more likely to experience medication harm related to the nontherapeutic use of medications including benzodiazepines and prescription opioids.
ER visits for children ages 5 and younger were most likely to involve unsupervised exposure to medications or adverse reactions to antibiotics.
Harm from medication was caused by various factors, such as people taking more than their prescribed dosages, people taking medications prescribed for other people, allergic reactions, and people using the medications for unapproved uses.
Hospitalization — which occurred in about a third of ER visits — was more likely to happen when patients took more than one medication, according to the report published in JAMA on October 5.
“The medications highlighted are often incredibly important, and not taking them can have serious consequences, such as uncontrolled diabetes, strokes, blood clots, etc., but it’s important to understand how to take them, what the risks are involved, and what steps can be taken to mitigate them,” said Dr. Dustin Cotliar, a board certified emergency medicine physician living in New Orleans.
In adults ages 65 and older, nearly 96 percent of the emergency room visits were related to medication harms from the therapeutic use of medications, most commonly related to anticoagulants such as warfarin and diabetes agents such as insulin.
Hospitalization was more common in people who took more than one medication.
About two-thirds of older adults have multiple chronic conditions, causing them to be prescribed multiple medications, according to Dr. Scott Kaiser, a board-certified geriatrician and director of the geriatric cognitive health program at the Pacific Brain Health Center at Pacific Neuroscience Institute at Providence Saint John’s Health Center in Santa Monica, California.
“This, along with physiologic changes which tend to occur with age, making many common medications potentially inappropriate or dangerous for many older adults, can result in a high risk for harm from medications or ‘adverse drug events,’” Kaiser said.
According to Cotliar, many older adults take anticoagulants to prevent blood clots and strokes, but the medications come with a risk of bleeding and complications.
Kaiser said that many of the ER visits were related to the need to adjust the patient’s doses of anticoagulants. There also appeared to be higher rates of anticoagulant-related visits in the newer direct-acting oral anticoagulant.
“The authors point out several ongoing efforts and broader opportunities to address these safety issues and assure that those who might benefit from anticoagulants can receive them in a way that most reduces the overall potential for harm,” Kaiser said.
Diabetes medications such as insulin may lead people to the ER due to low blood sugar or hypoglycemia, according to Cotliar.
Many people experience difficulty monitoring their blood sugar levels and using insulin. Low blood sugar can cause confusion, fainting, and falls.
“The findings of this study substantiate the need for continued efforts to reduce the unintended harms from diabetes medications, particularly for older adults, balancing the risks and benefits of keeping blood sugar tightly controlled with the risk of low blood sugar,” Kaiser said.
The most frequent reason for ER visits due to medication harms in younger adults ages 25 to 44 involved nontherapeutic use of benzodiazepines.
Benzodiazepines, which are commonly used for anxiety, muscle spasms, and seizures, can cause breathing difficulties if taken in excess or with other substances.
According to Kaiser, a high percentage of visits involved the benzodiazepine alprazolam (Xanax), taken in conjunction with alcohol and other substances, which increases the risk of overdose or other adverse events.
“High rates of side effects within younger age groups reflect their ubiquitous presence in our society, and a need to focus on mental health, substance abuse treatment, and suicide prevention,” Cotliar said.
Hospitalization rates were lowest among children ages 5 and under.
ER visits that involved medication harms in kids most commonly were due to unsupervised exposure to medications and negative reactions to the therapeutic use of antibiotics.
“This is not surprising given the frequency and extent to which these medications are prescribed to children, but serves as a reminder of their potential risks,” Kaiser said.
Kaiser hopes the findings highlight the need for healthcare professionals to avoid over-prescribing antibiotics, so that kids are only exposed to this potential risk when the benefits are clear.
New research found that blood thinners and diabetes medications send a significant amount of older adults to the ER each year.
Visits to the ER related to medication harms among younger adults were more likely to be related to the nontherapeutic use of benzodiazepines, combined with alcohol and other substances.
The authors of the study say the findings highlight a need to focus on mental health in young people and ensure older adults are safely and effectively balancing the benefits and risks of their prescribed medications.
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