November 25, 2010 |
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In 2004, there were an estimated 115,803 ED visits involving pharmaceutical misuse and abuse by older adults (Figure 1). In 2008, there were 256,097 such visits, representing an increase of 121.1 percent.
Year | Number of ED Visits |
---|---|
2004 | 115,803 |
2005 | 161,635 |
2006 | 193,062 |
2007 | 224,878 |
2008 | 256,097 |
Source: 2004 to 2008 SAMHSA Drug Abuse Warning Network (DAWN). |
Of ED visits involving pharmaceutical misuse or abuse by older adults, more than one third (35.6 percent) were made by those aged 50 to 54 (Figure 2). Visits by adults aged 55 to 59 accounted for 23.2 percent of such visits, and 19.7 percent were made by adults aged 70 or older.
Age | Number of ED Visits |
---|---|
Aged 50 to 54 | 35.6% |
Aged 55 to 59 | 23.2% |
Aged 60 to 64 | 11.9% |
Aged 65 to 69 | 9.6% |
Aged 70 or Older | 19.7% |
Source: 2008 SAMHSA Drug Abuse Warning Network (DAWN). |
Slightly more of these ED visits were made by females (53.6 percent) than by males. The majority of such visits were made by older non-Hispanic white adults (78.1 percent), 15.2 percent were made by older non-Hispanic black adults, and 5.2 percent were made by older Hispanic adults.
Pain relievers were the type of pharmaceutical most commonly involved (43.5 percent) in ED visits by older adults; the majority of these visits involved narcotic pain relievers (33.9 percent) (Table 1). After pain relievers, drugs used to treat anxiety or insomnia (31.8 percent) and antidepressants (8.6 percent) were the most commonly reported for such visits.
Drug Category | Estimated Number of ED Visits, Aged 50 or Older* |
Percentage of ED Visits, Aged 50 or Older* |
Estimated Number of ED Visits, Aged 50 to 64* |
Percentage of ED Visits, Aged 50 to 64* |
Estimated Number of ED Visits, Aged 65 or Older* |
Percentage of ED Visits, Aged 65 or Older* |
---|---|---|---|---|---|---|
Total ED Visits | 256,097 | 100.0% | 181,146 | 100.0% | 74,951 | 100.0% |
Alcohol | 52,160 | 20.4% | 45,058 | 24.9% | 7,102 | 9.5% |
Pain Relievers | 111,360 | 43.5% | 82,280 | 45.4% | 29,080 | 38.8% |
Narcotic Pain Relievers | 86,699 | 33.9% | 63,136 | 34.9% | 23,563 | 31.4% |
Drugs for Anxiety or Insomnia | 81,413 | 31.8% | 64,575 | 35.6% | 16,838 | 22.5% |
Benzodiazepines | 65,133 | 25.4% | 51,884 | 28.6% | 13,249 | 17.7% |
Antidepressants | 22,049 | 8.6% | 18,289 | 10.1% | 3,760 | 5.0% |
Anticonvulsants | 13,952 | 5.4% | 10,135 | 5.6% | 3,817 | 5.1% |
Antipsychotics | 13,437 | 5.2% | 11,196 | 6.2% | 2,240 | 3.0% |
Muscle Relaxants | 13,159 | 5.1% | 10,133 | 5.6% | 3,026 | 4.0% |
* Because multiple drugs may be involved in each visit, estimates of visits by drug may add to more than the total, and percentages may add to more than 100 percent. Source: 2008 SAMHSA Drug Abuse Warning Network (DAWN). |
Pain relievers were involved in 45.4 percent of visits by those aged 50 to 64 and 38.8 percent of visits by those aged 65 or older. Drugs used to treat anxiety or insomnia were involved more commonly in visits made by patients aged 50 to 64 than those made by patients aged 65 or older (35.6 vs. 22.5 percent). Antidepressants were involved in 10.1 percent of drug-related ED visits made by those aged 50 to 64 and 5.0 percent of visits by those aged 65 or older.
One in five (20.4 percent) ED visits related to pharmaceutical misuse or abuse by older adults also involved alcohol (Table 1). Visits involving alcohol in combination with pharmaceuticals were more likely to be made by adults aged 50 to 64 than by adults aged 65 or older (24.9 vs. 9.5 percent). Specifically, in comparison with patients aged 65 or older, patients aged 50 to 64 had a higher proportion of ED visits involving alcohol in combination with drugs used to treat anxiety and insomnia (47.3 vs. 32.1 percent) and alcohol in combination with antidepressants (13.2 vs. 5.0 percent).
Among older adults who visited the ED for pharmaceutical misuse or abuse, more than half (52.3 percent) were treated and released, and more than one third (37.5 percent) were admitted to the hospital. Of those admitted to the hospital, 60,378 were admitted to an inpatient unit (62.9 percent), 23,120 (24.1 percent) were admitted to an intensive care unit (ICU), and 11,695 (12.2 percent) were admitted to chemical dependency/detoxification or psychiatric unit.
Recent increases in the rate of pharmaceutical misuse and abuse among the baby boom generation, coupled with the anticipated growth in the number of older adults, will increase the demand for health care generally and for substance abuse treatment specifically. Health care costs for pharmaceutical misuse or abuse presenting to the ED can be great, especially if these cases result in hospital stays that require intensive care. The findings in this report show that more than one third of ED visits made by older adults misusing or abusing pharmaceuticals resulted in a hospital admission; of these, nearly a quarter of visits resulted in an admission to the ICU.
Because many substance abuse treatment and prevention programs were designed for adolescents and young adults, new approaches to addressing substance abuse in older adults may be necessary. Specifically, prevention messages that target older adults could warn against the dangerous combination of alcohol and pharmaceuticals. With one fifth of ED visits by older adults involving pharmaceutical misuse or abuse occurring among adults aged 70 or older, caregivers (e.g., adult children of aging parents) may be able to help prevent abuse by being alert to the symptoms and dangers. Education for caregivers about the abuse potential of certain medications and the early warning signs of abuse may be needed.
Moreover, the administration of pharmaceuticals requires oversight by medical professionals to guard against life-threatening interactions and dependency. Thus, it is important that physicians know about all pharmaceuticals (prescription and over-the-counter) a patient is taking before prescribing additional medications. Educating pharmacy and medical personnel as well as behavioral health specialists such as social workers and psychologists about substance abuse trends in older adults may help them to be more vigilant about the serious public health problem of pharmaceutical misuse and abuse by older adults.
The Drug Abuse Warning Network (DAWN) is a public health surveillance system that monitors drug-related morbidity and mortality. DAWN uses a probability sample of hospitals to produce estimates of drug-related emergency department (ED) visits for the United States and selected metropolitan areas annually. DAWN also produces annual profiles of drug-related deaths reviewed by medical examiners or coroners in selected metropolitan areas and States. Any ED visit related to recent drug use is included in DAWN. All types of drugs—licit and illicit—are covered. Alcohol is included for adults when it occurs with another drug. Alcohol always is reported for minors even if no other drug is present. The classification of drugs used in DAWN is derived from the Multum Lexicon, copyright 2009, Multum Information Services, Inc. The Multum Licensing Agreement governing use of the Lexicon can be found at http://dawninfo.samhsa.gov/drug_vocab. DAWN is one of three major surveys conducted by the Substance Abuse and Mental Health Services Administration's Center for Behavioral Health Statistics and Quality (SAMHSA/CBHSQ). For more information on other CBHSQ surveys, go to http://oas.samhsa.gov. SAMHSA has contracts with Westat (Rockville, MD) and RTI International (Research Triangle Park, NC) to operate the DAWN system and produce publications. For publications and additional information about DAWN, go to http://DAWNinfo.samhsa.gov/. |
The DAWN Report is published periodically by the Center for Behavioral Health Statistics and Quality (formerly the Office of Applied Studies), Substance Abuse and Mental Health Services Administration (SAMHSA). All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Additional copies of this report or other reports from the Center for Behavioral Health Statistics and Quality are available online: http://samhsa.gov/data/. Citation of the source is appreciated. For questions about this report, please e-mail: shortreports@samhsa.hhs.gov.
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This page was last updated on October 11, 2010. |