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Introduction: Thiazide diuretics are recommended as first-line therapy for hypertension in older adults. However, thiazides are also associated with hyponatraemia-related hospitalisations in older patients. This study aims to determine the predictors of hospitalisation due to thiazides usage in older adults. Methods: This is a retrospective matched case-control study. Patients aged ⩾65 admitted due to adverse drug reactions based on International Classification of Diseases, Ninth Revision (ICD9) codes from the period of 1 June to 31 December 2011 in Singapore General Hospital were extracted. Patients with the ICD9 code E944.3 Saluretics causing adverse effects in therapeutic use and who experienced thiazide-induced hyponatraemia were identified. Controls were identified from a pool of patients from outpatient clinics who were prescribed thiazide during the study period. Each case was matched to four controls based on gender and race. Patients’ demographics, length of stay, and cost of hospital admission were obtained. Results: In total, 19 cases with thiazide-induced hyponatraemia were matched with 76 controls. Cases were older than control (78.8±6.1 vs. 75.6±7.0, p =0.052), with the majority being females (84.2%) and Chinese (94.7%). The mean length of stay was 4 (±3) days; the mean cost of stay was SGD 1118 (±898). Serum potassium levels and concurrent use of beta-blockers were identified as unadjusted possible predictors for hospitalisation due to thiazide-induced hyponatraemia. Conclusion: Potential predictors of hospitalisation due to thiazide-induced hyponatraemia include low potassium levels and concurrent use of beta-blockers. Identification of predictors is crucial to guide safe and effective prescribing of thiazides in older patients.

Singaporeans are living longer and not having enough babies to replace themselves, with projected 20% of the population aged 65 years and above by 2030. These worrying trends can exert significant pressure on Singapore's economy and society. Health-resource utilisations are increasing as our population ages, with increase in hospitalisations, emergency room visits and consumption of pharmaceutical drugs. Interventions such as vaccinations in older people are well-studied approaches to prevent infections and the related complications. The Advisory Committee on Immunization Practice (ACIP) by the US Centers for Disease Control and Prevention (CDC) recommends routine immunisation against influenza, tetanus, pneumococcal pneumonia as well as herpes zoster infections in all people aged 65 years and above. The administrations of other vaccines (meningococcal, hepatitis A and B, varicella and Haemophilus influenzae type b) are recommended only in older people with certain risk factors. Despite the benefits of vaccination in older people, the data in the West shows that the rate of vaccination in this age group remains lower than targets recommended by the World Health Organisation (WHO). The main barriers to vaccinations exist in the healthcare system, health care providers, patients and caregivers. Interventions are warranted to increase awareness among physicians, to engage the involvement of the pharmacist/nurse to provide standing orders and reduction in cost of vaccination; this potentially improves vaccination uptake to protect our increasing elderly population.