Benzodiazepine exposure and 6-month mortality in older adults post-hospitalization: time to consider deprescribing?

BACKGROUND

Benzodiazepines (BZDs) are commonly used in older populations despite their association with multiple adverse outcomes. However, the impact of continuing versus deprescribing BZDs during hospitalization on short-term mortality after discharge remains uncertain. This study aims to evaluate the association of BZD-use at hospital discharge with 6-month mortality and explore whether in-hospital deprescribing modifies mortality risk.

METHODS

This is a retrospective analysis of prospectively collected data from patients (aged 66-101 years) consecutively admitted to an Acute Geriatric Unit. Upon admission, all patients underwent a Comprehensive Geriatric Assessment, including functional status, comorbidities, and medications review. A multivariable Cox regression model was used to evaluate the relationship between 6-month mortality and BZD prescription at hospital discharge (BZD nonusers, BZD at discharge, and BZD deprescribed).

RESULTS

Overall, 1375 patients (median age: 85.5 [IQR: 48-77, 55% females]) were included. Following therapeutic reconciliation, the BZD at discharge group was younger (p = .029), had lower frailty (p = .031), cognitive decline (p = .043), and in-hospital delirium (p < .001) prevalence than the BZD nonusers and BZD deprescribed groups. The BZD at discharge group (n = 130) showed a higher risk of all-cause 6-month mortality compared to BZD nonusers (n = 1066) (HR: 1.64; 95% CI: 1.14-2.37). Conversely, patients in whom BZDs were deprescribed during hospitalization (n = 179) exhibited a similar mortality risk as nonusers (HR: 0.97; 95% CI: 0.68-1.39).

CONCLUSIONS

BZDs prescription on hospital discharge was associated with an increased risk of 6-month mortality, whereas deprescription may mitigate this excess risk. Our data suggest that hospitalization may represent an opportunity to safely deprescribe BZDs in a controlled setting.