Medication-related admissions in older people: a cross-sectional, observational study.

BACKGROUND: Medication-related admissions are an important cause of hospital admissions in older people. The scope for prevention is less clear.
OBJECTIVES: To characterize medication-related hospital admissions in older people and assess their preventability.
METHODS: This was a cross-sectional, observational study conducted over 3 months. A pharmacist based in the medical admissions ward of a north London hospital screened all patients aged > or =65 years. A specialist physician assembled additional information, which was presented to a multi-professional panel to confirm attribution and preventability. A total of 409 patients were screened, of whom 14% (95% CI 10.6, 17.4) had medication-related problems, 6.4% (95% CI 4.0, 8.8) were admitted because of medication-related problems and 3.9% (95% CI 2.0, 5.8) were considered to have preventable medication-related problems. Medicines to prevent or treat cardiovascular disease were implicated in 69% (18/26) of the medication-related admissions and 69% (11/16) of preventable medication-related admissions. Amongst hospitalized patients, admission attributed to adverse drug reaction was more likely as the number of medications being taken increased, and admission attributed to undertreatment was more likely as the number of pre-existing conditions increased.
CONCLUSION: Medication-related admissions are common in older people and over half are preventable. Morbidity associated with medicines used for cardiovascular disease is important. There is a difficult balance to be struck between avoiding iatrogenic illness in older people and ensuring they benefit from medications for pre-existing conditions. Opportunities exist for improving the delivery of care to reduce adverse outcomes.