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We already know that polypharmacy is a big issue in the elderly, but here are a few key points to keep in mind:
1. Adverse drug effects are responsible for 11% of ED visits in the elderly.
2. Almost 50% of all adverse drug effects in the elderly are accounted for by only 3 drug classes:
a. oral anticoagulant or antiplatelet agents
b. antidiabetic agents
c. agents with narrow therapeutic index (e.g. digoxin and phenytoin)
3. 1/3 of all adverse-effect-induced ED visits are accounted for by warfarin, insulin, and digoxin.
4. Up to 20% of new prescriptions given to elderly ED patients represents a potential drug interaction.
The bottom line here is very simple--scrutinize that medication list and any new prescriptions in the elderly patient!
References
Samaras N, Chevalley T, Samaras D, et al. Older patients in the emergency department: a review. Ann Emerg Med 2010;56:261-269.