Journal of the American Geriatrics Society · 2025
Patterns of Benzodiazepines and Hypnotic Drugs Dispensing After Hip Fracture Among Older US Adults Previously on the Drugs.
СтатьяПоддержка NIH: внешняя программаНазвание и аннотация: Перевод в очереди
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Pan Meng, Duchesneau Emilie D, Miller Elyse M, Her Qoua L, Pate Virginia, Faurot Keturah R, Kim Dae Hyun, Stürmer Til
Аннотация
BACKGROUND: Benzodiazepines (BZD) and nonbenzodiazepine receptor agonist hypnotics (Z-drugs) strongly increase the risk for hip fractures and should be avoided among older adults with a fall or fracture history. We assessed BZD and Z-drugs refill patterns after discharge for hip fracture among older US adults and explored factors associated with refilling.
METHODS: We conducted a retrospective cohort study of US Medicare fee-for-service beneficiaries (20% random sample) aged ≥ 66 years, hospitalized for hip fracture, and discharged home or to a skilled nursing facility. Eligible patients had ≥ 365 days of Medicare Parts A, B, and D coverage and filled a BZD (2013-2019) or Z-drug (2008-2019) ≤ 90 days before hospitalization. We estimated cumulative incidences of refilling the same/increased dose (continuation) and reduced dose (reduction) and their corresponding 95% confidence intervals (CI) within 180 days after discharge, stratified by drug class. We examined demographic factors, comorbidities, and geriatric conditions associated with continuation versus deprescribing (reduction or no refill).
RESULTS: We included 21,123 eligible patients [11,465 (54%) on short/intermediate-acting BZD, 3473 (16%) on long-acting BZD, and 6185 (29%) on Z-drugs at baseline]. The median age was 82 years; 81% were female and 94% were non-Hispanic White. The continuation within 180 days post discharge was 54.9% (95% CI: 54.0%, 55.8%) for short/intermediate-acting BZD, 58.4% (56.7%, 60.1%) for long-acting BZD, and 56.0% (54.8%, 57.1%) for Z-drugs; 7.2%-16.3% refilled with dose reductions. Younger patients or those with anxiety were at higher risk of continuation.
CONCLUSIONS: A large proportion of US older adults on BZD or Z-drugs before hospitalization for a hip fracture continued the drugs within 180 days post hospital discharge. This highlights the need for comprehensive medication review and deprescribing intervention during transitions of care in this high-risk population.
METHODS: We conducted a retrospective cohort study of US Medicare fee-for-service beneficiaries (20% random sample) aged ≥ 66 years, hospitalized for hip fracture, and discharged home or to a skilled nursing facility. Eligible patients had ≥ 365 days of Medicare Parts A, B, and D coverage and filled a BZD (2013-2019) or Z-drug (2008-2019) ≤ 90 days before hospitalization. We estimated cumulative incidences of refilling the same/increased dose (continuation) and reduced dose (reduction) and their corresponding 95% confidence intervals (CI) within 180 days after discharge, stratified by drug class. We examined demographic factors, comorbidities, and geriatric conditions associated with continuation versus deprescribing (reduction or no refill).
RESULTS: We included 21,123 eligible patients [11,465 (54%) on short/intermediate-acting BZD, 3473 (16%) on long-acting BZD, and 6185 (29%) on Z-drugs at baseline]. The median age was 82 years; 81% were female and 94% were non-Hispanic White. The continuation within 180 days post discharge was 54.9% (95% CI: 54.0%, 55.8%) for short/intermediate-acting BZD, 58.4% (56.7%, 60.1%) for long-acting BZD, and 56.0% (54.8%, 57.1%) for Z-drugs; 7.2%-16.3% refilled with dose reductions. Younger patients or those with anxiety were at higher risk of continuation.
CONCLUSIONS: A large proportion of US older adults on BZD or Z-drugs before hospitalization for a hip fracture continued the drugs within 180 days post hospital discharge. This highlights the need for comprehensive medication review and deprescribing intervention during transitions of care in this high-risk population.