Use of BZD and sedative-hypnotics among hospitalized elderly



Clinical question: Which hospitalized older patients are inappropriately prescribed benzodiazepines or sedative hypnotics post discharge, and who is prescribing these medications?

Background: During hospitalization, older patients commonly suffer from agitation and insomnia. Unfortunately, benzodiazepines and sedative hypnotics are commonly used as first-line treatments for these conditions despite significant risk which includes cognitive impairment, postural instability, increased risk of falls and hip fracture as well as lack of effectiveness. The purpose of this study is to determine the magnitude of the issue, discover root causes, and determine the type or types of corrective action needed.

Study Design: Single-center retrospective observational study.

Setting: Urban academic medical center in Toronto.

Synopsis: Patient- and prescriber-level variables were identified and associated with potentially inappropriate newly prescribed benzodiazepine or sedative-hypnotics to medical-surgical inpatients aged 65 or older (regular users were excluded), which amounted to 208 patients of the 1,308 patients studied. The majority of the indications were for insomnia or agitation/anxiety prescribed overnight with 222 out of 1,308 patients (15.9%).

There was significant increase in these prescriptions if the patient was admitted to a surgical or specialty service compared to the general internal medicine service (odds ratio, 6.61; 95% confidence interval, 2.70-16.17). First-year trainees prescribed these medications more than did attending or fellows (OR, 0.28; 95% CI, 0.08-0.93).

Study limitations include being from a single institution, not being blinded, and inadequate statistical power. Therefore, it may lack generalizability, may be subjected to observer bias, and may not detect significant effects of covariates.

Bottom line: Sleep disruption and poor quality of sleep were the primary reason for the majority of potentially inappropriate newly prescribed benzodiazepines and sedative hypnotics, with first-year trainees being more likely to prescribe these medications compared to attendings and fellows.

Citation: Pek EA, Ramfry A, Pendrith C, et al. High prevalence of inappropriate benzodiazepine and sedative hypnotic prescriptions among hospitalized older adults. J Hosp Med. 2017 May;12(5):310-6.

Dr. Choe is a hospitalist at Ochsner Health System, New Orleans.

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