Initiation of benzodiazepines in the elderly after hospitalization.
OBJECTIVE
To estimate the rate of new chronic benzodiazepine use after hospitalization in older adults not previously prescribed with benzodiazepines.


METHODS
Retrospective cohort study using linked, population-based administrative data.


METHODS
Ontario, Canada between April 1, 1992 and March 31, 2005.


METHODS
Community-dwelling seniors who had not been prescribed benzodiazepine drugs in the year before hospitalization were selected from all 1.4 million Ontario residents aged 66 years and older.


METHODS
New chronic benzodiazepine users, defined as initiation of benzodiazepines within 7 days after hospital discharge and an additional claim within 8 days to 6 months. We used multivariate logistic regression to examine for the effect of hospitalization on the primary outcome after adjusting for confounders.


RESULTS
There were 405,128 patient hospitalizations included in the cohort. Benzodiazepines were prescribed to 12,484 (3.1%) patients within 7 days of being discharged from hospital. A total of 6,136 (1.5%) patients were identified as new chronic benzodiazepine users. The rate of new chronic benzodiazepine users decreased over the study period from 1.8% in the first year to 1.2% in the final year (P < .001). Multivariate logistic regression found that women, patients admitted to the intensive care unit or nonsurgical wards, those with longer hospital stays, higher overall comorbidity, a prior diagnosis of alcoholism, and those prescribed more medications had significantly elevated adjusted odds ratios for new chronic benzodiazepine users. Older individuals had a lower risk for the primary outcome.


CONCLUSIONS
New benzodiazepine prescription after hospitalization occurs frequently in older adults and may result in chronic use. A systemic effort to address this risky practice should be considered.
Bell
Chaim M
CM
Department of Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, Canada, M5B 1W8. bellc@smh.toronto.on.ca
Fischer
Hadas D
HD
Gill
Sudeep S
SS
Zagorski
Brandon
B
Sykora
Kathy
K
Wodchis
Walter P
WP
Herrmann
Nathan
N
Bronskill
Susan E
SE
Lee
Phil E
PE
Anderson
Geoff M
GM
Rochon
Paula A
PA
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use*; D002170:Canada; D015331:Cohort Studies; D015897:Comorbidity; D011307:Drug Prescriptions; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D016017:Odds Ratio; D010351:Patient Discharge; D012189:Retrospective Studies
D014151:Anti-Anxiety Agents; D001569:Benzodiazepines