Four Drugs Cause Most Hospitalizations in Older Adults

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Via: New York Times – November 23, 2011, 5:00 PM

Four Drugs Cause Most Hospitalizations in Older Adults

Some medications may cause some dangerous reactions.Tony Cenicola/The New York TimesSome medications may cause dangerous reactions.
Blood thinners and diabetes drugs cause most emergency hospital visits for drug reactions among people over 65 in the United States, a new study shows.
Just four medications or medication groups — used alone or together — were responsible for two-thirds of emergency hospitalizations among older Americans, according to the report. At the top of the list was warfarin, also known as Coumadin, a blood thinner. It accounted for 33 percent of emergency hospital visits. Insulin injections were next on the list, accounting for 14 percent of emergency visits.
Aspirin, clopidogrel and other antiplatelet drugs that help prevent blood clotting were involved in 13 percent of emergency visits. And just behind them were diabetes drugs taken by mouth, called oral hypoglycemic agents, which were implicated in 11 percent of hospitalizations.
All these drugs are commonly prescribed to older adults, and they can be hard to use correctly. One problem they share is a narrow therapeutic index, meaning the line between an effective dose and a hazardous one is thin. The sheer extent to which they are involved in hospitalizations among older people, though, was not expected, said Dr. Dan Budnitz, an author of the study and director of the Medication Safety Program at the Centers for Disease Control and Prevention.
“We weren’t so surprised at the particular drugs that were involved,” Dr. Budnitz said. “But we were surprised how many of the emergency hospitalizations were due to such a relatively small number of these drugs.”
Every year, about 100,000 people in the United States over age 65 are taken to hospitals for adverse reactions to medications. About two-thirds end up there because of accidental overdoses, or because the amount of medication prescribed for them had a more powerful effect than intended.
As Americans live longer and take more medications — 40 percent of people over 65 take five to nine medications — hospitalizations for accidental overdoses and adverse side effects are likely to increase, experts say.
In the latest study, published in The New England Journal of Medicine, Dr. Budnitz and his colleagues combed through data collected from 2007 to 2009 at 58 hospitals around the country. The hospitals were all participating in a surveillance project run by the C.D.C. that looks at adverse drug events.
A common denominator among the drugs topping the list is that they can be difficult to use. Some require blood testing to adjust their doses, and a small dose can have a powerful effect. Blood sugar can be notoriously hard to control in people with diabetes, for example, and taking a slightly larger dose of insulin than needed can send a person into shock. Warfarin, meanwhile, is the classic example of a drug with a narrow margin between therapeutic and toxic doses, requiring regular blood monitoring, and it can interact with many other drugs and foods.
“These are medicines that are critical,” Dr. Budnitz said, “but because they cause so many of these harms, it’s important that they’re managed appropriately.”
One thing that stood out in the data, the researchers noted, was that none of the four drugs identified as frequent culprits are typically among the types of drugs labeled “high risk” for older adults by major health care groups. The medications that are usually designated high risk or “potentially inappropriate” are commonly used over-the-counter drugs like Benadryl, as well as Demerol and other powerful narcotic painkillers. And yet those drugs accounted for only about 8 percent of emergency hospitalizations among the elderly.
Dr. Budnitz said that the new findings should provide an opportunity to reduce the number of emergency hospitalizations in older adults by focusing on improving the safety of this small group of blood thinners and diabetes medications, rather than by trying to stop the use of drugs typically thought of as risky for this group.
“I think the bottom line for patients is that they should tell all their doctors that they’re on these medications,” he said, “and they should work with their physicians and pharmacies to make sure they get appropriate testing and are taking the appropriate doses.”

Pediatric deaths due to varicella are becoming a thing of the past

Varicella simplex (Chickenpox) on a child Skull.                       Image via Wikipedia Source: MD Consult

ST LOUIS (MD Consult) – With implementation of the varicella vaccination program in the United States, deaths due to the disease among children and adolescents have virtually ceased, finds a study reported in the August 2011 issue of Pediatrics.

Using data from the Mortality Multiple Cause-of-Death records of the US National Center for Health Statistics, investigators analyzed temporal patterns of deaths among individuals of all ages for which varicella was listed as an underlying or contributing cause between 1990 and 2007. The vaccination program was introduced in 1995.

Over the first 12 years of the program, the annual average mortality rate for varicella listed as the underlying cause fell by 88%, from 0.41 per million population in 1990-1994 to 0.05 per million population in 2005-2007.

The same pattern was evident across all age-groups. The reduction was 97%, 90%, and 67% among children and adolescents younger than 20 years, among adults aged 20 to 49 years, and among adults aged 50 years or older, respectively.

In the last 6 years analyzed (2002-2007), there were 3 deaths each among children aged 1 to 4 years and aged 5 to 9 years; in sharp contrast, there were an average of 13 and 16 deaths annually, respectively, before the vaccine was introduced.

All of the deaths among children and adolescents younger than 20 years in 2002-2007 occurred in those who did not have high-risk conditions as strictly defined by the study, although 3 occurred in children or adolescents having conditions that could increase risk.

“The impressive decline in varicella deaths can be directly attributed to successful implementation of the 1-dose vaccination program,” the investigators conclude. “With the current 2-dose program, there is potential that these most severe outcomes of a vaccine-preventable disease could be eliminated.”

Pediatrics. 2011;128:214-220.

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H1N1 less lethal than feared: U.K. study

Last Updated: Thursday, December 10, 2009 | 3:34 PM ET Comments285Recommend89

Medical advances such as ventilators and intensive care were not available during previous pandemics. Medical advances such as ventilators and intensive care were not available during previous pandemics. (CBC)The strain of swine flu virus currently circulating around the world is less deadly than previously thought, say British scientists who compared its effect to that of other pandemic viruses.
The 2009 flu pandemic is about 100 times less lethal than the 1918 Spanish flu and nearly 10 times less fatal than the flu pandemics of 1957 and 1968.
Those findings were reported in Thursday’s online issue of British Medical Journal, BMJ.
After analyzing British health department data on all reported swine flu patients who were hospitalized between July and Nov. 8 , the researchers estimated that about 26 of every 100,000 people infected with the H1N1 influenza A virus that causes swine flu died. That is a death rate of 0.026 per cent.
The findings are similar to a U.S. study published on Monday that estimated the death rate in the current swine flu pandemic is 0.048 per cent, or one death per every 2,000 cases.
“The first influenza pandemic of the 21st century is considerably less lethal than was feared in advance,” England’s chief medical officer, Liam Donaldson, and his co-authors from Britain’s Health Protection Agency wrote in the study.
In comparison, the fatality rate for the 1918 Spanish flu pandemic was two to three per cent, compared with around 0.2 per cent for the pandemics in 1957-1958 and 1967-1968. Fatality estimates for previous pandemics were probably less reliable since they were based on statistical methods and death certificates, with few — if any — lab confirmations.
Since the past pandemics, there have been advances in medicine such as ventilators to help patients with breathing problems, as well as better housing, health care and nutrition, Donaldson said.
When the World Health Organization declared swine flu had reached a pandemic stage in June, the agency described it as “moderate,” with most people infected showing mild symptoms and recovering without medical treatment.
A pandemic designation reflects how widely a virus has spread, not the severity of illness.

Findings not a reason for inaction

Donaldson’s study suggested two-thirds of those who died from H1N1 would be eligible for the H1N1 vaccine under the British government’s plan, which prioritizes those at highest risk of developing complications from the flu.
This includes patients sick in hospital, pregnant women, people with asthma or other underlying health problems and health care workers.
“Viewed statistically, mortality in this pandemic compares favourably with 20th century influenza pandemics. A lower population impact than previous pandemics, however, is not a justification for public health inaction,” the study’s authors concluded. “Our data support the priority vaccination of high-risk groups.”
Some of the deaths, 38 per cent, occurred in people not considered at high risk.
The findings also reinforced calls to prescribe antiviral medications for people at high risk or those showing severe symptoms.
Most of the people who died of swine flu in Britain, 78 per cent, had been prescribed antiviral drugs. But of these, 76 per cent did not received them within the first 48 hours of illness as recommended.

Infection rate higher among native populations

Also on Thursday, U.S. health officials said an estimated 15 per cent of Americans had been infected with the H1N1 virus by mid November.
In its weekly report on death and disease, the U.S. Centers for Disease Control and Prevention (CDC) suggested the death rate among the aboriginal population in the U.S. is about four times higher than that of all other racial and ethnic groups combined.
Similarly, indigenous populations in Australia, Canada and New Zealand have been found to have a three to eight times higher rate of hospitalization and death associated with swine flu.
There is a lot of debate about why the rates are higher among aboriginal populations, but it likely reflects environmental conditions such as nutrition in early childhood, access to health care and the a higher likelihood of un

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