More Patients Being Hospitalized for Drug-related Issues

The number of middle-aged and elderly patients being hospitalized for problems relating to both legitimate medications and illegal drugs has risen sharply.

The number of hospital admissions among Americans ages 45 and older for medication and drug-related conditions doubled between 1997 and 2008, according to report from the Agency for Healthcare Research and Quality (AHRQ). Medication and drug-related conditions include effects of both prescription and over-the-counter medications, as well as illicit drugs.

Hospital admissions in patients age 45 years and older were driven by an increase in discharges for three types of medication and drug-related conditions: drug-induced delirium; "poisoning" or overdose by codeine, meperidine and other opiate-based pain medicines; and withdrawal from narcotic or non-narcotic drugs, according to the AHRQ.

Admissions for all medication and drug-related conditions grew by 117%—from 30,100 to 65,400—for patients between the ages of 45 and 64 years between 1997 and 2008. The rate of admissions for those ages 65 to 84 closely followed, growing by 96%, and for people ages 85 and older, the rate grew by 87%. By comparison, the number of hospital admissions for these conditions among adults ages 18 to 44 declined slightly by 11%.

"This report reveals a disturbing trend, and we need to find out more about why these admissions are increasing," said AHRQ Director Carolyn M. Clancy, MD, in a statement. "As the average age of hospital patients continues to increase, so does the need for close monitoring of the types and dosages of drugs given to them."

Drug-induced delirium or dementia can be caused by sleeping pills as well as drugs for urinary incontinence, nausea and other problems common in the elderly, but doctors sometimes can’t identify the cause. Poisoning by pain medicines or other drugs containing codeine, meperidine or other opiates can be caused by accidental overdosing or the failure to recognize the drug's active ingredient.

The Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration provided data in the report on hospital care for mental health and substance abuse disorders."Substance abuse is rising, and drug abuse of all kinds is exploding as a major public health concern for our country," said SAMHSA Administrator Pamela S. Hyde. "The challenge for our health care practitioners is to see that patients receive medications when there is medical need but also to help prevent the adverse health consequences from drug use."

The new AHRQ report also shows that Medicare and Medicaid were responsible for 57% of the $1.1 billion cost to hospitals in 2008 for treating patients with medication and drug-related conditions, private insurance covered 24%, and the uninsured accounted for 14%. The remaining 5 percent of hospital costs for treating these conditions were borne by other sources such as TRICARE.

To read the full AHRQ report, click here.

What can hospitalists and other health care providers to do help prevent the adverse consequences of drug use in patients?

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