New Canadian research indicates that older adults admitted to hospital are often prescribed common tranquillizers called benzodiazepines, and may be at risk for becoming dependent on the drugs once they return home.
Many patients are prescribed benzodiazepines while in hospital to help them sleep or to alleviate anxiety, says Dr. Chaim Bell, a researcher with the University of Toronto, St. Michael’s Hospital and the Institute for Clinical Evaluative Sciences in Toronto.
“Even though people might require benzodiazepines temporarily in hospital, we need to build in systems so that those benzodiazepines aren’t continued after they’re discharged,” Bell says.
Benzodiazepine use in older adults has been associated with greater risks of cognitive impairment, motor vehicle accidents and hip fractures. These risks can be increased when benzodiazepines are used in combination with other drugs or alcohol.
Bell and his colleagues studied more than 400,000 Ontario seniors who were hospitalized between 1992 and 2005 and were discharged home again after their stay in hospital. None had been prescribed benzodiazepines in the year before their hospitalization.
More than three per cent of these seniors filled a prescription for benzodiazepines within seven days of being released from hospital. About half of those patients (1.5 per cent of the total group) filled at least one more prescription for benzodiazepines within six months of discharge.
Bell notes that even though only a small percentage of seniors were identified as chronic users, the risk of chronic use and dependence continues with successive hospital stays. “The more hospitalizations you go through, the more chance you’re going to be prescribed this on a regular basis.”
Length of stay in hospital was the most significant risk factor for chronic use. Seniors who spent four to nine days in hospital had nearly twice the risk of patients who spent one to three days in hospital. Those who spent 10 days or more in hospital had three times the risk, compared with those who stayed one to three days.
“I don’t want to underemphasize the need for sleep and anxiety treatment in the hospital,” Bell says. “It’s the post-hospitalization issue that’s really at issue in this, because that’s where a lot of the risk of the adverse effects of benzodiazepine use comes from.”