Department of Geriatric Medicine, CHU Dinant Godinne UCL Namur, Avenue Dr Gaston Therasse, 1, 5530, Yvoir, Belgium.
Institute of Health and Society, Université Catholique de Louvain, Clos Chapelle aux Champs, 30 Bte B1. 30.13, 1200, Brussels, Belgium.
BMC Geriatr. 2022 Feb 1;22(1):88. doi: 10.1186/s12877-022-02753-w.
Benzodiazepine receptor agonist (BZRA) use is highly prevalent in hospitalised older people although these drugs are associated with numerous and serious adverse events. Deprescribing can reduce risks associated with chronic BZRA use. The aim of this study was to measure the prevalence of, and factors associated with, BZRA deprescribing in acute geriatric units.
During a one-year period, this multicentre retrospective study included patients aged ≥70 years, hospitalised in acute geriatric units, and using ≥1 BZRA on admission. BZRA deprescribing at discharge was defined as: ≥25% decrease in lorazepam-equivalent admission dose; discontinuation of all BZRAs; or cessation of a rescue prescription at discharge. BZRA cessation was defined as discontinuation of all BZRAs at discharge. We identified social, medical, geriatric and medication factors associated with BZRA deprescribing using logistic regression.
In total, 561 patients were included (mean age: 85.3±5.9 years, 70% of women). BZRA deprescribing occurred in 240 (42.8%), including 85 with BZRA cessation (15.2%). Deprescribing occurred more frequently in patients with a BZRA-related adverse event on admission or during hospital stay (odds ratio (OR) 4.5; 95% confidence interval [2.6; 7.9]), with an antidepressant (1.6 [1.1; 2.4]) and a higher lorazepam-equivalent dosage on admission (OR 1.2 [1; 1.4]), and less frequently in patients with antipsychotic drug (OR 0.5 [0.3; 0.8]). BZRA cessation was more likely in patients with a BZRA-related adverse event (OR 2.2 [1.2; 4.3]) and a lower lorazepam-equivalent dosage on admission (OR 0.5 [0.3; 0.6]).
During hospitalisation in the acute geriatric units of our hospital, BZRA deprescribing occurred in 42.8% of the patients. Identification of an BZRA-related adverse event by the treating physician appears to be a major factor: this reactive deprescribing accounted for 74% of cases in our study. Further prospective studies are needed to measure long-term persistence of in-hospital deprescribing and encourage proactive management.
苯二氮䓬类受体激动剂（BZRA）在住院老年人中使用非常普遍，尽管这些药物与许多严重的不良事件有关。减少 BZRA 的使用可以降低与慢性 BZRA 使用相关的风险。本研究的目的是测量急性老年病房中 BZRA 减少使用的发生率和相关因素。
在为期一年的时间里，这项多中心回顾性研究纳入了年龄≥70 岁、住院于急性老年病房、入院时使用≥1 种 BZRA 的患者。出院时 BZRA 减少使用的定义为：劳拉西泮等效剂量减少≥25%；所有 BZRAs 的停药；或出院时停止使用抢救处方。BZRA 的停药定义为出院时所有 BZRA 的停药。我们使用逻辑回归识别与 BZRA 减少使用相关的社会、医学、老年和药物因素。
共纳入 561 例患者（平均年龄：85.3±5.9 岁，70%为女性）。240 例（42.8%）患者发生 BZRA 减少使用，其中 85 例（15.2%）发生 BZRA 停药。入院或住院期间有 BZRA 相关不良事件（优势比[OR]4.5；95%置信区间[2.6；7.9]）、抗抑郁药（1.6 [1.1；2.4]）和较高的劳拉西泮等效剂量（OR 1.2 [1；1.4]）的患者更易发生 BZRA 减少使用，而使用抗精神病药物（OR 0.5 [0.3；0.8]）的患者则较少发生。入院时发生 BZRA 相关不良事件（OR 2.2 [1.2；4.3]）和较低的劳拉西泮等效剂量（OR 0.5 [0.3；0.6]）的患者更易发生 BZRA 停药。
在我们医院的急性老年病房住院期间，42.8%的患者发生了 BZRA 减少使用。治疗医生识别出与 BZRA 相关的不良事件似乎是一个主要因素：在我们的研究中，这种反应性的减少使用占病例的 74%。需要进一步的前瞻性研究来衡量住院期间减少使用的长期持续情况，并鼓励主动管理。
