Drug effects blamed for fifth of hospital deaths among elderly

BMJ 2001; 323 doi: (Published 03 November 2001) Cite this as: BMJ 2001;323:1025
  1. Scott Gottlieb
  1. New York

    A Norwegian study has shown that drug related side effects may contribute to nearly a fifth of all hospital deaths in elderly patients, particularly those who have more than one illness or are taking multiple medications (Archives of Internal Medicine 2001;161:2317-23). In almost half the cases looked at, inappropriate drugs were prescribed or the wrong doses or forms of drugs used.

    Researchers at the Central Hospital of Akershus, Norway, analysed the records of all 732 patients who died among the 13992 patients admitted to the hospital's department of internal medicine over a two year period. Dr Just Ebbesen and his team found that the cause of death in 133 (18%) of the patients was classified as either an indirect or direct fatal reaction to the drugs they were given.

    In 75 of the 133 patients with fatal drug reactions, postmortem findings or drug analysis data were decisive in recognising the drug's role in the patient's demise; in the rest, the role was strongly suggested by a combination of clinical data. The main groups of drugs implicated were cardiovascular, antithrombotic, and sympathomimetic agents.

    Fatal drug effects were most common in patients who died of gastrointestinal diseases. Fatal drug effects were more common in older men but not in older women. In addition, the more drugs a patient was taking, the higher the risk of fatal side effects. The risk also grew with the number of illnesses a patient had.

    In many of the drug related deaths the drugs were prescribed correctly. But in just under half of the cases, either inappropriate drugs were prescribed or the wrong doses or forms were used. The conclusions were drawn after patients had died, when postmortem results were available. This meant that few of the drug related fatal effects were included in the patient's medical chart or reported to hospital authorities.

    Although it was difficult to judge how many of the elderly patients' deaths might have been preventable, the researchers placed most of the blame for the deaths on misinterpretations of symptoms, and lack of monitoring of drug concentrations.

    Embedded Image

    Ghost-like images of empty “cure-all” bottles are presented in an exhibition entitled “Secret Remedies.” The paintings of 19th century medicine bottles by Michelle Charles appear at the Museum of the Royal Pharmaceutical Society, London, until 4 January 2002. It was announced last month that the museum, established in 1842 as a teaching collection of drug specimens, is to close next year.

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