Inappropriate medication administration to the acutely ill elderly: a nationwide emergency department study, 1992-2000.
OBJECTIVE
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.


METHODS
Retrospective analysis of ED visits in the 1992-2000 National Hospital Ambulatory Medical Care Survey. Inappropriate medications identified using Beers' 1997 explicit criteria.


METHODS
EDs of U.S. noninstitutionalized general and short-stay hospitals.


METHODS
ED survey patients aged 65 and older.


METHODS
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.


CONCLUSIONS
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.
Caterino
Jeffrey M
JM
Department of Emergency Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA. jeffreycaterino@hotmail.com
Emond
Jennifer A
JA
Camargo
Carlos A
CA
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D000075202:Contraindications; D003430:Cross-Sectional Studies; D004363:Drug Utilization / Q000706:statistics & numerical data / Q000639:trends*; D064420:Drug-Related Side Effects and Adverse Reactions; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005853:Geriatrics / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D016015:Logistic Models; D008297:Male; D004364:Pharmaceutical Preparations; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
D004364:Pharmaceutical Preparations