Association between sedative prescriptions after hospital discharge and falls and other adverse events in older adults: a population-based cohort study

Background — Whether sedative prescriptions after hospital admissions are associated with poor patient outcomes is unknown. We sought to determine the incidence and risk of adverse events associated with sedatives in older adults within 30 days after hospital discharge.

Methods — We conducted a population-based cohort study involving older adults (age ≥ 66 yr) discharged alive from hospital in Ontario (2003 to 2023). We assessed the association of sedative prescriptions (benzodiazepines, antidepressant sedatives, or antipsychotics) filled within 7 days after discharge with falls (with or without fracture), emergency department (ED) visits, and hospital readmission. We used cause-specific proportional hazard regression for outcomes other than death and Cox proportional hazard models for death to assess the association between a sedative prescription filled after discharge and the outcomes. Because of an interaction with prehospital sedative prescription, we stratified results for prehospital sedative-naive and sedative-exposed status.

Results — Among 1 868 484 older adults (mean age 77 yr, 52.1% female), 13.2% filled a sedative prescription after discharge; of these patients, 31.0% were sedative naive before hospital admission. Falls occurred in 1.6% (n = 30 626), ED visits in 21.3% (n = 397 402), hospital readmissions in 12.4% (n = 231 191), and death in 3.8% (n = 70 661). The adjusted hazard ratio (HR) for all outcomes was increased among those who filled a sedative prescription after discharge (v. no filled prescription) and were sedative naive before hospital admission (fall: 1.20, 95% confidence interval [CI] 1.13 to 1.26; ED visit 1.20, 95% CI 1.19 to 1.22; hospital readmission: 1.20, 95% CI 1.17 to 1.22; and death: 1.78, 95% CI 1.73 to 1.83). For those who were exposed to sedatives before their hospital admission, there was an increased hazard of death (adjusted HR 1.08, 95% CI 1.05 to 1.11), but not for the other outcomes. For sedative-naive older adults, benzodiazepines were associated with an increased hazard of all outcomes, antipsychotics were associated with an increased hazard of falls and death, and antidepressant sedatives were associated with a decreased hazard of falls.

Interpretation — New sedative prescriptions filled within 7 days after discharge were associated with increased hazards of a fall, ED visit, hospital admission, and death within 30 days after discharge, with differences based on the sedative class. These findings have important implications for in-hospital medication review and falls-risk assessment for older adults in Canada.