Poly-pharmacy among the elderly in a Danish emergency department

Background

A substantial part of the clientele in an emergency department setting are elderly patients who often consume several prescription medications daily hereby increasing the risk of potential drug-drug interactions. We examined the extent of poly-pharmacy at the time of admission among a group of elderly patients.

Methods

All patients in the age range 65-79 years admitted consecutively to Holbaek Emergency Department during one week were included. Information on medication at the time of admission was obtained from medical charts.

Results

A total of 73 patients, 48% women and 52% men were included, the average age being 72 years. The most frequent reasons for admission were lung diseases (21%), neurological disease (25%), cardiac diseases (15%) and infections (12%). The patients used on average 6.6 prescription medications daily, ranging from 0 to18 different drugs. 10 patients received 1 drug or less. The most frequently used drugs in this group were anti-hypertensive medication (56% of the patients), blood-cholesterol lowering drugs (55% of the patients), drugs to prevent thrombosis (56% of the patients), pain medication (37% of the patients) and diuretics (36% of the patients).

A total of 41 patients were prescribed anti-hypertensive medications. 20 patients were prescribed more than one drug to control blood pressure and 5 of these patients were treated with more than two different drugs to control blood pressure. 18 patients in anti-hypertensive treatment were also treated with diuretics. The most frequently prescribed anti-hypertensive drugs were calcium antagonists (n=15), beta-receptor blockers (n=15)and ACE-inhibitors (n=14).

A total of 40 patients were prescribed drugs to lower blood cholesterol and 75% (n=30) of these were treated with simvastatin. 41 patients were prescribed drugs to prevent thrombosis, among these acetylsalicylic acid (n=25), clopidogrel (n= 11) and warfarin (n= 10) were the most frequently used drugs.

27 patients were treated with pain medication at the time of admission and 15 of these patients received opioids.

Conclusion

Cardiovascular drugs are the most predominantly prescribed drugs for elderly patients. Poly-pharmacy is in particular seen among antihypertensive medications. Caution in prescribing new drugs due to potential drug-drug interactions poses a challenge for the attending physician.