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Patterns of benzodiazepine administration and prescribing to older adults in U.S. emergency departments.
Aging Clin Exp Res. 2020 Dec; 32(12):2621-2628.AC

Abstract

OBJECTIVES

Benzodiazepine use in older adults is associated with adverse effects including delirium, mechanical falls, fractures, and memory disturbances. In this study we examine the overall utilization of benzodiazepines in the older adult population in U.S. EDs.

METHODS

Data were compiled from the National Hospital Ambulatory Medical Care Survey 2005-2015. Variables were created to identify all patients over 60 years of age who had and had not been administered benzodiazepines. Bivariate statistical tests were utilized to examine patient demographics, hospital course events and ED/hospital resource allocation and compare older adults administered (in the ED) and prescribed (from the ED) benzodiazepines to those not receiving these agents.

RESULTS

Between 2005 and 2015 approximately 280 million adults over 60 years of age were seen in EDs throughout the U.S. Overall, benzodiazepines were administered in the ED (only) during 8.5 million visits, and prescribed as a prescription (only) during over 1.3 million visits, with the rate increasing from 2.7% in 2005 to 3.5% in 2015 for benzodiazepines were administered in the ED (only). Overall 42.1% (95% CI 38.8-45.2, p < 0.001) of older adults administered benzodiazepines in the ED were subsequently admitted to the hospital. Rates of co-administration and co-prescription of opioid analgesics were high at 19.0% (95% CI 7.3-19.7) and 17.0% (95% CI 7.9-17.4) for those administered benzodiazepines in the ED, and 21.8% (95% CI 16.3-28.5) and 34.5% (95% CI 27.7-42.0) amongst those prescribed benzodiazepines at discharge. In both cases, these groups were no less likely to be administered opioids in the ED than those not receiving benzodiazepines. A total of 1.1% (95% CI 0.69-1.7, p < 0.001) of older adults administered (in the ED) benzodiazepines were diagnosed with delirium in the ED, compared to 0.0004% who were not (95% CI 0.0038-0.0052).

CONCLUSION

Despite the documented risks associated with the utilization of benzodiazepines in older adults, the rate of use in EDs continues to increase. Older adults administered benzodiazepines in the ED were more likely to be admitted to the hospital than those not receiving these agents. Despite the risks associated with co-prescription of benzodiazepines with opioids, those receiving these agents were no less likely to be administered opioids than those who did not. Older adults administered benzodiazepines in the ED were substantially more likely to be diagnosed with delirium in the ED.

Authors+Show Affiliations

Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, 2120 L St., Washington, DC, 20037, USA. pourmand@gwu.edu.Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, 2120 L St., Washington, DC, 20037, USA.Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, 2120 L St., Washington, DC, 20037, USA.Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32056152

Citation

Pourmand, Ali, et al. "Patterns of Benzodiazepine Administration and Prescribing to Older Adults in U.S. Emergency Departments." Aging Clinical and Experimental Research, vol. 32, no. 12, 2020, pp. 2621-2628.
Pourmand A, Lombardi KM, Roberson J, et al. Patterns of benzodiazepine administration and prescribing to older adults in U.S. emergency departments. Aging Clin Exp Res. 2020;32(12):2621-2628.
Pourmand, A., Lombardi, K. M., Roberson, J., & Mazer-Amirshahi, M. (2020). Patterns of benzodiazepine administration and prescribing to older adults in U.S. emergency departments. Aging Clinical and Experimental Research, 32(12), 2621-2628. https://doi.org/10.1007/s40520-020-01496-1
Pourmand A, et al. Patterns of Benzodiazepine Administration and Prescribing to Older Adults in U.S. Emergency Departments. Aging Clin Exp Res. 2020;32(12):2621-2628. PubMed PMID: 32056152.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patterns of benzodiazepine administration and prescribing to older adults in U.S. emergency departments. AU - Pourmand,Ali, AU - Lombardi,Kevin M, AU - Roberson,Jeffrey, AU - Mazer-Amirshahi,Maryann, Y1 - 2020/02/13/ PY - 2019/11/06/received PY - 2020/01/23/accepted PY - 2020/2/15/pubmed PY - 2020/11/26/medline PY - 2020/2/15/entrez KW - Benzodiazepine KW - Emergency department KW - Older adult SP - 2621 EP - 2628 JF - Aging clinical and experimental research JO - Aging Clin Exp Res VL - 32 IS - 12 N2 - OBJECTIVES: Benzodiazepine use in older adults is associated with adverse effects including delirium, mechanical falls, fractures, and memory disturbances. In this study we examine the overall utilization of benzodiazepines in the older adult population in U.S. EDs. METHODS: Data were compiled from the National Hospital Ambulatory Medical Care Survey 2005-2015. Variables were created to identify all patients over 60 years of age who had and had not been administered benzodiazepines. Bivariate statistical tests were utilized to examine patient demographics, hospital course events and ED/hospital resource allocation and compare older adults administered (in the ED) and prescribed (from the ED) benzodiazepines to those not receiving these agents. RESULTS: Between 2005 and 2015 approximately 280 million adults over 60 years of age were seen in EDs throughout the U.S. Overall, benzodiazepines were administered in the ED (only) during 8.5 million visits, and prescribed as a prescription (only) during over 1.3 million visits, with the rate increasing from 2.7% in 2005 to 3.5% in 2015 for benzodiazepines were administered in the ED (only). Overall 42.1% (95% CI 38.8-45.2, p < 0.001) of older adults administered benzodiazepines in the ED were subsequently admitted to the hospital. Rates of co-administration and co-prescription of opioid analgesics were high at 19.0% (95% CI 7.3-19.7) and 17.0% (95% CI 7.9-17.4) for those administered benzodiazepines in the ED, and 21.8% (95% CI 16.3-28.5) and 34.5% (95% CI 27.7-42.0) amongst those prescribed benzodiazepines at discharge. In both cases, these groups were no less likely to be administered opioids in the ED than those not receiving benzodiazepines. A total of 1.1% (95% CI 0.69-1.7, p < 0.001) of older adults administered (in the ED) benzodiazepines were diagnosed with delirium in the ED, compared to 0.0004% who were not (95% CI 0.0038-0.0052). CONCLUSION: Despite the documented risks associated with the utilization of benzodiazepines in older adults, the rate of use in EDs continues to increase. Older adults administered benzodiazepines in the ED were more likely to be admitted to the hospital than those not receiving these agents. Despite the risks associated with co-prescription of benzodiazepines with opioids, those receiving these agents were no less likely to be administered opioids than those who did not. Older adults administered benzodiazepines in the ED were substantially more likely to be diagnosed with delirium in the ED. SN - 1720-8319 UR - https://www.unboundmedicine.com/medline/citation/32056152/Patterns_of_benzodiazepine_administration_and_prescribing_to_older_adults_in_U_S__emergency_departments_ L2 - https://dx.doi.org/10.1007/s40520-020-01496-1 DB - PRIME DP - Unbound Medicine ER -