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The 100,000 hospitalizations figure is real. The argument built on it usually is not.

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The most quoted number in this field is that adverse drug events cause roughly 100,000 emergency hospitalizations a year among older Americans. The number is real. The argument that usually follows it is not.

The number

National active surveillance data for adults aged 65 and over produced an estimate of 99,628 emergency hospitalizations per year for adverse drug events (95% CI 55,531 to 143,724), with 48.1% of those in adults aged 80 and over. That is a sound figure from a sound study.

What the same study found about which drugs

Four drugs or classes accounted for 67.0% of those hospitalizations: warfarin 33.3%, insulins 13.9%, oral antiplatelets 13.3% and oral hypoglycemics 10.7%.

And the sentence that almost never travels with the headline figure: “High-risk medications were implicated in only 1.2% (95% CI, 0.7 to 1.7) of hospitalizations.” A 2016 update using the same surveillance system put medications on the Beers “always avoid” list at 1.8% of emergency department visits for adverse drug events.

Why this matters for a deprescribing program

The argument usually built on the 100,000 figure runs: adverse drug events cause enormous harm, therefore we should reduce potentially inappropriate prescribing. The first half is true. The second does not follow from it, because the drugs causing that harm are overwhelmingly anticoagulants and diabetes agents — drugs that in most cases should not be stopped.

What those drugs need is better dosing, better monitoring, better follow-up on renal function and on hypoglycemia. That is a different program from a Beers-list review, it requires different work, and pointing the 100,000 figure at the Beers list actively directs attention away from where the harm is.

The honest version

There are strong reasons to review and reduce potentially inappropriate prescribing in older adults. The best of them is that a large share of long-term care prescriptions are treating nothing at all — 65.3% of proton pump inhibitor prescriptions in one US skilled-nursing study had no supporting diagnostic code. A drug treating nothing carries only risk, and that argument does not need to borrow a statistic that is about something else.

Read more: The AGS Beers Criteria — what it is and what it is not.

References

  1. Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for adverse drug events in older Americans. The New England Journal of Medicine. 2011;365(21):2002–2012. PMID 22111719 · DOI 10.1056/NEJMsa1103053.
  2. Shehab N, Lovegrove MC, Geller AI, Rose KO, Weidle NJ, Budnitz DS. US Emergency Department Visits for Outpatient Adverse Drug Events, 2013-2014. JAMA. 2016;316(20):2115–2125. PMID 27893129 · DOI 10.1001/jama.2016.16201.
  3. Patterson Burdsall D, Flores HC, Krueger J, et al. Use of proton pump inhibitors with lack of diagnostic indications in 22 Midwestern US skilled nursing facilities. Journal of the American Medical Directors Association. 2013;14(6):429–432. PMID 23583000 · DOI 10.1016/j.jamda.2013.01.021.
  4. By the 2023 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society. 2023;71(7):2052–2081. PMID 37139824 · DOI 10.1111/jgs.18372.

Bibliographic records in this note were retrieved from PubMed. Every reference links to its DOI or PubMed record.

Written and medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP, founder and medical director of DWARAA. Last reviewed . This page is educational. DWARAA does not prescribe, deprescribe, diagnose or treat.

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