Anticoagulants and diabetes drugs send a significant amount of adults ages 65 and older to the emergency room each year.

[seasider18]

New research looking into adverse effects from medication use found that anticoagulants (blood thinners) and diabetes drugs send a significant amount of adults ages 65 and older to the emergency room each year.

Younger adults, between the ages of 25 and 44, were more likely to experience medication harm related to the nontherapeutic use of medications including benzodiazepines and prescription opioids.

ER visits for children ages 5 and younger were most likely to involve unsupervised exposure to medications or adverse reactions to antibiotics.

Harm from medication was caused by various factors, such as people taking more than their prescribed dosages, people taking medications prescribed for other people, allergic reactions, and people using the medications for unapproved uses.

Hospitalization — which occurred in about a third of ER visits — was more likely to happen when patients took more than one medication, according to the report published in JAMATrusted Source on October 5.

“The medications highlighted are often incredibly important, and not taking them can have serious consequences, such as uncontrolled diabetes, strokes, blood clots, etc., but it’s important to understand how to take them, what the risks are involved, and what steps can be taken to mitigate them,” said Dr. Dustin Cotliar, a board certified emergency medicine physician living in New Orleans.

Older adults and warfarin, insulin

In adults ages 65 and older, nearly 96 percent of the emergency room visits were related to medication harms from the therapeutic use of medications, most commonly related to anticoagulants such as warfarin and diabetes agents such as insulin.

Hospitalization was more common in people who took more than one medication.

About two-thirds of older adults have multiple chronic conditions, causing them to be prescribed multiple medications, according to Dr. Scott Kaiser, a board-certified geriatrician and director of the geriatric cognitive health program at the Pacific Brain Health Center at Pacific Neuroscience Institute at Providence Saint John’s Health Center in Santa Monica, California.

“This, along with physiologic changes which tend to occur with age, making many common medications potentially inappropriate or dangerous for many older adults, can result in a high risk for harm from medications or ‘adverse drug events,’” Kaiser said.

According to Cotliar, many older adults take anticoagulants to prevent blood clots and strokes, but the medications come with a risk of bleeding and complications.

Kaiser said that many of the ER visits were related to the need to adjust the patient’s doses of anticoagulants. There also appeared to be higher rates of anticoagulant-related visits in the newer direct-acting oral anticoagulant.

“The authors point out several ongoing efforts and broader opportunities to address these safety issues and assure that those who might benefit from anticoagulants can receive them in a way that most reduces the overall potential for harm,” Kaiser said.

Diabetes medications such as insulin may lead people to the ER due to low blood sugar or hypoglycemia, according to Cotliar.

Many people experience difficulty monitoring their blood sugar levels and using insulin. Low blood sugar can cause confusion, fainting, and falls.

“The findings of this study substantiate the need for continued efforts to reduce the unintended harms from diabetes medications, particularly for older adults, balancing the risks and benefits of keeping blood sugar tightly controlled with the risk of low blood sugar,” Kaiser said.

[secondtry]

Thanks Seasider interesting. One of the reasons I have postponed taking DOACs was their relative newness with limited track record. Naively, I thought there would be in due course transparent and comprehensive reporting of side effects including studies to give a balanced view for the patient.......after seeing what has happened championing the Covid vaccine to the exclusion of all else and censorship of any useful cheap repurposed drug to save lives, I am not expecting that anymore!

[Hidden]

All medications harm some people! It's maybe not too surprising that a high proportion of people taking any anti-coagulant are seen in A&E. Because we're expressly told to report there in the event of any incident which might have caused significant bleeding, seen or unseen. That's inevitable and why we have a system for reporting side effects (certainly in UK). And why there are long lists of possibilities on the explanatory leaflets which are provided with every prescription medication and many over the counter ones too.I think that, as individuals, it is up to us to weigh the benefits against any possible side effects or harm that may temporarily or permanently be caused to us by taking them. Most of the time, scientists have already weighed many of these when developing a particular drug and certainly they go through rigorous testing before being permitted to be used. But this is not a finite process.

Sadly, through time there have been drugs which have escaped the net and caused irreparable damage to human beings, thalidomide and the unborn child, for example. But a lot's been learned from such tragedies. Caution over a new treatment should be the norm but sometimes urgency is often the watchword, as in the case of something like the vaccines for covid19 for example. They have been, of necessity, produced at high speed and it's understandable if the nervous question efficacy or safety.

However, without those who are brave enough, we could never advance treatments as a species, and I'm glad I usually have enough courage to take a risk or two in the hope that a particular treatment might help not only me, but others too.

I'm old. I believe that, at my age, I am fortunate to be helped to live a few more years in reasonable health, thanks to a variety of prescribed medications for multiple conditions. I always try to keep sight of the fact that anyone who has been born is inevitably going to die. And for the older generation, with or without medications, we are in the departure lounge. Quite often it feels that anything which might help us to delay final take-off is probably worth the risk of some side effects or even a trip to A&E.

[seasider18 in reply to Hidden]

Departure lounge... I like that. The area of Eastbourne we live in is called Gods Waiting Room due to the prevelance of older people. Two of our neighbours got to 102 and a lot of us are in our late 80's and 90's.

[Hidden in reply to seasider18]

I like that too seasider18!😊

[Auriculaire]

I suspect that the increased visits for DOACs are partly due to the one size fits all prescribing regime. With Warfarin the dose is matched to the INR . This can result in very big differences between individuals in the amount needed to stay in the recommended INR range. How many individuals on DOACs are taking the prescribed dose when they would be adequately anticoagulated on three quarters or even a half of that dose? No attempt seems to being made to find this out.

[seasider18 in reply to Auriculaire]

My INR had was never very stable and I often had big swings from week to week even though I kept to quite a strict diet.Someone I know has been on Warfarin for thirty years and hers never varies.

[Buffafly in reply to Auriculaire]

There is a protocol for advising a half dose of new anticoags but I am not sure GPs keep an eye on that.

For Apixaban : The recommended dose is 5 mg twice daily.The dose should be reduced to 2.5 mg twice daily in people with:

At least two of the following characteristics: age 80 years or over, body weight 60 kg or less, serum creatinine 133 micromol/L or over.

Quote from NICE

[Auriculaire in reply to Buffafly]

Thanks Buffafly . I was aware of that but I suspect a lot of people on DOACs aren't and that some docs ignore it anyway. But there could be still lots of people outside those categories for whom the full dose is too much - or not enough. No account is taken of genetic differences in drug metabolism . This is something that has only been discovered fairly recently so it will probably be years before anything is done to change prescribing habits.

[seasider18 in reply to Auriculaire]

I was put on Warfarin after going into AF after having my aortic valve replaced with a tissue one. Later three consultants offered to change it to a DOAC when I had problems with Warfarin. I told them that DOACs were contraindicated because of the tissue valve, They each said we can over ride that it is just that no tissue valve patients were included in the trials,.

[RoyMacDonald]

What a load of rubbish. Not an ex Daily Mail headline writer are you?All the best.

Roy

[Lorna058]

The research looks sound to me. Personally I haven’t experienced any problems with my warfarin.I’m 77and have been on warfarin for AF for 5 years. I do my own testing and phone results through to the clinic, which saves hospital visits for testing. I guess everyone has different experiences