Potentially Inappropriate Prescribing of Benzodiazepines for Older Adults and Risk of Falls During a Hospital Stay: A Descriptive Study
Bibliographic record
Abstract
Background: Falls have been identified as a potential adverse event associated with the administration of psychotropic medications to older patients.Objective: The objective of this exploratory study was to examine the association between potentially inappropriate prescribing of benzodiazepines, as defined by the Beers criteria, by older adults (at least 65 years of age) and the risk of having a fall during acute inpatient care.Methods: This 1-year retrospective cross-sectional study of discharges from a tertiary care hospital in Halifax, Nova Scotia, used pharmacy data to identify the prescription of benzodiazepines listed in the updated Beers criteria as being associated with an increased risk of falls. These data were linked with information on in-hospital falls from occurrence report forms.Results: For 5831 (58.1%) of the 10 044 discharges, the patient had received a prescription for at least one benzodiazepine during the hospital stay. A total of 574 falls were reported (for 374 patients), and 226 (39.4%) of the falls resulted in an injury. According to the Beers criteria, for 936 (9.3%) of the discharges, the patient had received a prescription for at least one potentially inappropriate benzodiazepine. However, there was no statistically significant difference between patients with a prescription for a potentially inappropriate benzodiazepine and those receiving an appropriate or no benzodiazepine in terms of occurrence of falls (4.5% versus 3.8%, p = 0.30) or fall-related injuries (2.6% versus 1.8%, p = 0.08). The median length of stay was about 3 days longer for the former group (9 versus 6 days, p < 0.001).Conclusions:The findings from the current study do not support use of the Beers criteria related to benzodiazepines alone for identifying patients at risk of falls or injuries.RÉSUMÉ Contexte : Les chutes comptent parmi les effets indésirables potentiels associés à l’administration de psychotropes à des patients âgés.Objectif : L’objectif de cette étude exploratoire était d’examiner le lien entre la prescription potentiellement inappropriée de benzodiazépines, selon les critères de Beers, chez les personnes âgées (au moins 65 ans) et le risque de chute durant une hospitalisation pour soins de courte durée.Méthodes : Cette étude rétrospective transversale d’une durée d’un an des congés d’un hôpital de soins tertiaires de Halifax, en NouvelleÉcosse, a fait appel aux données de la pharmacie pour retracer la prescription de benzodiazépines répondant aux critères actualisés de Beers comme étant associé à un risque de chute accru. Ces données ont ensuite été mises en parallèle avec l’information sur les chutes survenues à l’hôpital tirée des formulaires de déclaration d’incidents.Résultats : À l’égard de 5831 (58,1%) des 10 044 congés, le patient avait reçu une ordonnance pour au moins une benzodiazépine durant son séjour à l’hôpital. Un total de 574 chutes ont été déclarées (pour 374 patients), et 226 (39,4%) de celles-ci ont causé une blessure. D’après les critères de Beers, au moins une benzodiazépine potentiellement inappropriée a été prescrite au patient à l’égard de 936 (9,3%) des congés examinés. Il n’y avait cependant aucune différence statistiquement significative dans la survenue des chutes (4,5% contre 3,8%, p = 0,30) ou dans les blessures associées aux chutes (2,6% contre 1,8%, p = 0,08) entre le groupe de patients ayant reçu une ordonnance pour une benzodiazépine potentiellement inappropriée et celui ayant reçu une benzodiazépine appropriée ou n’en n’ayant pas reçu. La durée médiane du séjour à l’hôpital était d’environ trois jours de plus pour le premier groupe (9 contre 6 jours, p < 0,001).Conclusions : Les résultats de cette étude ne corroborent pas l’emploi des critères de Beers associés aux benzodiazépines seules pour dépister les patients à risque de chutes ou de blessures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".