Prescribing Patterns and Impact of Sedatives in Hospitalized Older Adults: A Secondary Analysis of the MedSafer Study

IF 4.5 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society Pub Date : 2025-03-23 DOI:10.1111/jgs.19437

Bennet Desormeau, Allen Huang, James Downar, Peter E. Wu, Emilie Bortolussi-Courval, Sydney B. Ross, Kiran Battu, Louise Papillon-Ferland, Finlay A. McAlister, Sarah Elsayed, Marnie Goodwin Wilson, Rodrigo B. Cavalcanti, Emily G. McDonald, Todd C. Lee

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Abstract

Background

We aimed to examine the impact of sedative prescription patterns in hospitalized older adults on post-discharge adverse drug events (ADEs), falls, and sleep.

Methods

We conducted a secondary analysis of the MedSafer randomized controlled trial (RCT; NCT03272607) which included hospitalized adults ≥ 65 years of age who were taking ≥ 5 medications. We identified patients who completed follow-up at 30 days post-discharge and provided patient-reported outcomes for sleep disturbance (PROMIS SD 4a). We grouped patients based on sedative use as follows: nonusers, continued home use (pre- and post-hospitalization), deprescribed home use, and new use at discharge. Using multivariable logistic regression, we compared the odds of patients having experienced ≥ 1 ADE (not necessarily ascribed to sedatives), a fall, or any adverse event within 30 days post-discharge. We also used ordinal logistic regression and a minimal important difference approach to compare the change in sleep disturbance at 30 days post-discharge.

Results

The cohort comprised 3630 patients with a median age of 78. A total of 2810 (77.4%) were categorized as nonusers; 475 (13.1%) continued home use; 293 (8.1%) deprescribed home use; and 52 (1.4%) new users at discharge. Compared to the continued home use group, the deprescribed group was substantially less likely to experience an ADE post-discharge (adjusted odds ratio [aOR], 0.39 [95% CI, 0.16–0.97]). Correspondingly, new users at discharge had substantially higher odds of falls (aOR, 2.51 [95% CI, 1.13–5.61]). Favorable changes in sleep disturbance were more likely among nonusers (aOR, 1.29 [95% CI, 1.05–1.58]) and deprescribed users (aOR, 1.11 [95% CI, 0.82–1.50]) when compared to continued users.

Conclusions

In this cohort, patients who had their sedatives deprescribed were 61% less likely than continued users to have a post-discharge ADE, and new sedative use at discharge was associated with appreciable risk of falls. Hospitalization likely represents a window of opportunity to improve care by promoting sedative deprescription and avoiding new starts.

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住院老年人镇静剂的处方模式和影响：MedSafer研究的二次分析

背景：我们旨在研究住院老年人的镇静剂处方模式对出院后药物不良事件（ADE）、跌倒和睡眠的影响：我们对 MedSafer 随机对照试验（RCT；NCT03272607）进行了二次分析，该试验纳入了年龄≥ 65 岁、服用药物≥ 5 种的住院成年人。我们确定了在出院后 30 天完成随访的患者，并提供了患者报告的睡眠障碍结果（PROMIS SD 4a）。我们根据镇静剂的使用情况对患者进行了如下分组：未使用、继续在家中使用（入院前和入院后）、无处方在家中使用和出院时新使用。通过多变量逻辑回归，我们比较了患者在出院后 30 天内发生≥ 1 次 ADE（不一定归因于镇静剂）、跌倒或任何不良事件的几率。我们还使用了序数逻辑回归和最小重要差异法来比较出院后 30 天内睡眠障碍的变化：组群包括 3630 名患者，中位年龄为 78 岁。共有 2810 人（77.4%）被归类为非使用者；475 人（13.1%）继续在家中使用；293 人（8.1%）不再在家中使用；52 人（1.4%）为出院时的新使用者。与继续在家用药组相比，停药组出院后发生 ADE 的几率要低得多（调整后的几率比 [aOR]，0.39 [95% CI，0.16-0.97]）。相应地，出院时新用药者发生跌倒的几率要高得多（aOR，2.51 [95% CI，1.13-5.61]）。与持续使用者相比，非使用者（aOR，1.29 [95% CI，1.05-1.58]）和停药使用者（aOR，1.11 [95% CI，0.82-1.50]）的睡眠障碍更有可能发生有利的变化：在该队列中，与继续使用镇静剂的患者相比，开具镇静剂处方的患者出院后发生 ADE 的几率要低 61%，出院时新使用镇静剂与明显的跌倒风险有关。住院期间很可能是通过促进镇静剂处方和避免重新使用镇静剂来改善护理的机会之窗。

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来源期刊

Journal of the American Geriatrics Society 医学-老年医学

CiteScore

10.00

自引率

6.30%

发文量

504

审稿时长

3-6 weeks

期刊介绍： Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.