Pmh20: Dosing of Benzodiazepine Hypnotics in Elderly Patients

Abstract

OBJECTIVES: Use of benzodiazepines in elderly patients has been associated with adverse outcomes including motor vehicle accidents and hip fractures from falls. Evidence exists showing greater risk of adverse outcomes with higher doses of these drugs regardless of drug half‐life. Initial administration of lower doses to elderly and debilitated patients is generally recommended for benzodiazepine hypnotics. We analyzed whether these recommendations are generally followed when prescribing these drugs to inpatients. METHODS: Demographic and hospital information for all patients receiving flurazepam, triazolam, or temazepam between January 1998 and June 2000 was extracted from Solucient's Projected Inpatient International Classification of Clinical Services (pICCS) database. This database contains demographic, hospital, clinical, and detailed service level information for inpatients from over 150 short‐term, non‐federal, US hospitals. The percent of elderly patients (over age 65) receiving the recommended dose was determined. The relationship of patient age, hospital teaching status, bed size, and geographic region on the likelihood of following dosing recommendations was analyzed. RESULTS: We extracted information for 14,929 inpatients receiving flurazepam, 8,147 inpatients receiving triazolam, and 125,625 patients receiving temazepam. Among elderly patients receiving one of these drugs, 72.1% of patients receiving flurazepam, 49.8% of patients receiving temazepam, and 7.1% of patients receiving triazolam received the recommended dose. For all three drugs, patient age was directly correlated with the likelihood of receiving the recommended dose. There was no consistent relationship between teaching status, hospital bed size, or geographic region and the likelihood of receiving the recommended dose, although teaching hospitals were much more likely than non‐teaching hospitals to provide the recommended dose for temazepam and triazolam (OR 5.3 CI 4.9–5.8 for temazepam; OR 2.7 CI 2.2–3.2 for triazolam). CONCLUSIONS: Many elderly inpatients are prescribed higher than recommended doses of hypnotic benzodiazepines, suggesting need for systemic interventions to avert adverse outcomes.