New sedative prescriptions increase fall risks for discharged older adults

Older adults discharged from hospital with a new prescription for a sedative, especially a benzodiazepine or antipsychotic, are at increased risk of falls and other negative consequences, according to new research published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.251965.

"Our results showed that discharging older adults after an acute care hospital stay with a new prescription for these medications was associated with an increased hazard of falls requiring medical attention, further need for acute hospital care, and death in the 30 days after hospital discharge, whereas individuals with prior exposure did not experience the same increased hazards," writes Dr. Lisa Burry, clinician scientist at Mount Sinai Hospital, Sinai Health and University of Toronto, Toronto, Ontario, with coauthors.

Falls are a major public health burden and affect older adults in particular. Sedatives and antipsychotics are associated with adverse events, and clinical guidance discourages prescribing these potentially inappropriate medications for older adults.

The study of more than 1.86 million adults aged 66 years and older aimed to understand prescribing patterns to inform discharge prescribing in future. Based on ICES data, it looked at all patients discharged from hospital between April 2003 and August 2023. In total, 13% (246 440) filled at least 1 prescription for any sedative within 7 days of discharge, and about one-third (76 335) of them had not filled a prescription for a sedative within the 6-month period before hospitalization. The risk of falls was 20% higher in people with a new sedative prescription, and the risk of an emergency department visit, readmission, and death within 30 days was also increased. 

"Although the overall absolute magnitude of the risk of adverse events identified was modest from a population perspective, the effects on patients and their families are clinically and socially important," write the authors. "Moreover, given the volume of hospital admissions among older adults and the aging population, a modest increase in risk translates into a large impact on the health care system."

The authors suggest caution when prescribing these medications on hospital discharge, ensuring medical follow-up 1 to 2 weeks after discharge to monitor patients, continue risk assessment, and review the need for the prescription.

"Given the identified associations, clinicians must consider whether new sedative prescriptions are essential or can be deprescribed or de-escalated before or shortly after hospital discharge. When ongoing sedative use is required, community support, such as falls or mobility assessments, and ongoing medication reviews may help mitigate risks," the authors conclude.