Key result
Stopping hypnotics in geriatric inpatients is linked to ~9-fold higher odds of persistent post-discharge discontinuation.
Why the study?
Deprescribing long-term hypnotic drugs is recommended in older adults to reduce harm, but whether this is feasible in geriatric inpatients was unknown.
Does cessation of hypnotic drugs during hospitalization improve discontinuation rates one month after discharge in geriatric inpatients?
Observational (n=96)
No
Does cessation of hypnotic drugs during hospitalization improve discontinuation rates one month after discharge in geriatric inpatients?
Odds Ratio: 9.43 (95% CI 3.23–32.13)
p-value: p=<0.001
In geriatric inpatients, stopping hypnotic drugs during hospitalization is a strong determinant of persistent discontinuation one month post-discharge without deteriorating sleep quality.
May support inpatient hypnotic deprescribing in older adults to aid sustained discontinuation; leaves open causal effects and sleep outcomes in randomized trials.
BackgroundDeprescribing long-term hypnotic drug use is recommended in older adults to reduce medication-related harm such as falls. It is currently unknown whether this might be feasible in geriatric inpatients. The aim of this study was hence to determine predisposing factors for discontinuation of benzodiazepines and Z-drugs one month after discharge in geriatric inpatients receiving usual care.MethodsA prospective observational study was performed at the University Hospitals Leuven (UZ Leuven, Belgium). Patient characteristics, hypnotic drug use and sleep quality were gathered up to one month after discharge. A multivariable logistic regression model was used to identify independent determinants.ResultsChronic hypnotic drug use was highly prevalent (26.6%) in the geriatric population of UZ Leuven. Ninety-six patients with a mean age of 85.7 (SD 4.7) years admitted to the acute geriatric ward over a period of 10 months were included for analysis. Upon admission, 74% used a benzodiazepine and 26% a Z-drug. One month after discharge, 35 patients (36.5%) discontinued the hypnotic drug and in 23 cases (24.0%) the equivalent daily dose was reduced. Cessation of the hypnotic drug during hospitalization was found to be the only determinant influencing discontinuation one month after discharge with an odds ratio of 9.43 (95% confidence interval: 3.23 – 32.13). This was not associated with any deterioration of sleep quality.ConclusionsThis study confirms the overuse of long-term BZD and Z-drug use in geriatric patients. Cessation of hypnotic drugs during hospitalization was strongly associated with persistent discontinuation one month after discharge.Trial registrationThe study was approved by the Ethics Committee of UZ Leuven (registration number B322201629331).
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Brantegem et al. (2020) conducted an observational in Chronic hypnotic drug use (benzodiazepines and Z-drugs) (n=96). Cessation of hypnotic drugs during hospitalization vs. No cessation during hospitalization was evaluated on Hypnotic discontinuation one month after discharge (OR 9.43, 95% CI 3.23-32.13, p=<0.001). Cessation of hypnotic drugs during hospitalization was strongly associated with persistent discontinuation one month after discharge in geriatric inpatients (OR 9.43).
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