Prescribing Patterns and Impact of Sedatives in Hospitalized Older Adults: A Secondary Analysis of the <scp>MedSafer</scp> Study
Bibliographic record
Abstract
BACKGROUND: We aimed to examine the impact of sedative prescription patterns in hospitalized older adults on post-discharge adverse drug events (ADEs), falls, and sleep. METHODS: We conducted a secondary analysis of the MedSafer randomized controlled trial (RCT; NCT03272607) which included hospitalized adults ≥ 65 years of age who were taking ≥ 5 medications. We identified patients who completed follow-up at 30 days post-discharge and provided patient-reported outcomes for sleep disturbance (PROMIS SD 4a). We grouped patients based on sedative use as follows: nonusers, continued home use (pre- and post-hospitalization), deprescribed home use, and new use at discharge. Using multivariable logistic regression, we compared the odds of patients having experienced ≥ 1 ADE (not necessarily ascribed to sedatives), a fall, or any adverse event within 30 days post-discharge. We also used ordinal logistic regression and a minimal important difference approach to compare the change in sleep disturbance at 30 days post-discharge. RESULTS: The cohort comprised 3630 patients with a median age of 78. A total of 2810 (77.4%) were categorized as nonusers; 475 (13.1%) continued home use; 293 (8.1%) deprescribed home use; and 52 (1.4%) new users at discharge. Compared to the continued home use group, the deprescribed group was substantially less likely to experience an ADE post-discharge (adjusted odds ratio [aOR], 0.39 [95% CI, 0.16-0.97]). Correspondingly, new users at discharge had substantially higher odds of falls (aOR, 2.51 [95% CI, 1.13-5.61]). Favorable changes in sleep disturbance were more likely among nonusers (aOR, 1.29 [95% CI, 1.05-1.58]) and deprescribed users (aOR, 1.11 [95% CI, 0.82-1.50]) when compared to continued users. CONCLUSIONS: In this cohort, patients who had their sedatives deprescribed were 61% less likely than continued users to have a post-discharge ADE, and new sedative use at discharge was associated with appreciable risk of falls. Hospitalization likely represents a window of opportunity to improve care by promoting sedative deprescription and avoiding new starts.
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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 | 0.004 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.003 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".