Patterns of Benzodiazepines and Hypnotic Drugs Dispensing After Hip Fracture Among Older US Adults Previously on the Drugs

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. 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). 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. 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.