title: High-Risk Medications in Hospitalized Elderly Adults: Are We Making It Easy to Do the Wrong Thing?
abstract: OBJECTIVE
  To examine dosages of high-risk medications administered to elderly adults who fall in the hospital and to determine whether electronic default doses are appropriate for elderly adults.
  
  
  METHODS
  Retrospective.
  
  
  METHODS
  Large urban academic hospital.
  
  
  METHODS
  Individuals aged 65 and older experiencing a fall.
  
  
  METHODS
  Prescribed daily dosages and use of high-risk medications (opiates, benzodiazepines, benzodiazepine-receptor agonists (BRAs), sleep medications, muscle relaxants, antipsychotics) administered within 24 hours before a fall were ascertained and compared with published recommended dosages for older adults and the hospital's electronic medical record (EMR) default doses for these drugs.
  
  
  RESULTS
  Of 328 falls, 62% occurred in individuals administered at least one high-risk medication within the 24 hours before the fall, with 16% of the falls involving individuals receiving two, and another 16% in individuals receiving three or more. High-risk medications were often administered at higher-than-recommended geriatric daily doses, in particular benzodiazepines and BRAs, for which the dose was higher than recommended in 29 of 51 cases (57%). Hospital EMR default doses were higher than recommended for 41% (12/29) of medications examined.
  
  
  CONCLUSIONS
  High-risk medications were administered to older fallers. Doses administered and EMR default doses were often higher than recommended. Decreasing EMR default doses for individuals aged 65 and older and warnings about the cumulative numbers of high-risk medications prescribed per person may be simple interventions that could decrease inpatient falls.
authors.affiliation: Division of Geriatric Medicine and Palliative Care, Department of Medicine, School of Medicine, New York University, New York, New York.
authors.forename: Nina L
authors.initials: NL
authors.lastname: Blachman
authors.affiliation: Departments of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.|Departments of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Rosanne M
authors.initials: RM
authors.lastname: Leipzig
authors.affiliation: Departments of Medicine and Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Madhu
authors.initials: M
authors.lastname: Mazumdar
authors.affiliation: Departments of Medicine and Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Jashvant
authors.initials: J
authors.lastname: Poeran
mesh_terms: D000046:Academic Medical Centers; D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects; D001569:Benzodiazepines / Q000008:administration & dosage / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D058785:GABA-A Receptor Agonists / Q000008:administration & dosage / Q000009:adverse effects; D006760:Hospitalization; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects; D057970:Inappropriate Prescribing; D009125:Muscle Relaxants, Central / Q000008:administration & dosage / Q000009:adverse effects; D009518:New York; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid; D014150:Antipsychotic Agents; D058785:GABA-A Receptor Agonists; D006993:Hypnotics and Sedatives; D009125:Muscle Relaxants, Central; D001569:Benzodiazepines
keywords: default dosing; falls; high-risk medications