Initiation of benzodiazepines in the elderly after hospitalization
Initiation of benzodiazepines in the elderly after hospitalization
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DOI：
10.1007/s11606-007-0194-4
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发表时间：
2007-07-01
影响因子：
5.7
通讯作者：
Rochon, Paula A.
中科院分区：
文献类型：
--
作者：
Bell, Chaim M.;Fischer, Hadas D.;Rochon, Paula A.
目的：估计以前未开过苯二氮卓类药物的老年人住院后新的慢性苯二氮卓类药物使用率。设计：使用关联的、基于人群的管理数据进行回顾性队列研究。地点：1992年4月1日至2005年3月31日期间的加拿大安大略省。参与者：从所有140万安大略省居民中选择住院前一年内未开过苯二氮卓类药物的社区居住老年人66 岁及以上。主要结果指标：新的慢性苯二氮卓类药物使用者，定义为出院后 7 天内开始使用苯二氮卓类药物，并在 8 天至 6 个月内额外索赔。在调整混杂因素后，我们使用多变量逻辑回归来检查住院对主要结局的影响。结果：该队列中有 405,128 名患者住院。出院后 7 天内，有 12,484 名患者（3.1%）接受了苯二氮卓类药物治疗。共有 6,136 名（1.5%）患者被确定为新的慢性苯二氮卓类使用者。研究期间新的慢性苯二氮卓类药物使用者比例从第一年的 1.8% 下降到最后一年的 1.2% (P < .001)。多变量逻辑回归发现，女性、入住重症监护病房或非手术病房的患者、住院时间较长、总体合并症较高、先前诊断为酒精中毒的患者以及服用更多药物的患者，新慢性苯二氮卓类药物使用者的调整比值比显着升高。老年人出现主要结局的风险较低。结论：住院后新开苯二氮卓类药物处方在老年人中经常发生，并可能导致长期使用。应考虑采取系统性措施来解决这种危险做法。
Objective: To estimate the rate of new chronic benzodiazepine use after hospitalization in older adults not previously prescribed with benzodiazepines.Design: Retrospective cohort study using linked, population-based administrative data.Setting: Ontario, Canada between April 1, 1992 and March 31, 2005.Participants: Community-dwelling seniors who had not been prescribed benzodiazepine drugs in the year before hospitalization were selected from all 1.4 million Ontario residents aged 66 years and older.Main outcome measures: New chronic benzodiazepine users, defined as initiation of benzodiazepines within 7 days after hospital discharge and an additional claim within 8 days to 6 months. We used multivariate logistic regression to examine for the effect of hospitalization on the primary outcome after adjusting for confounders.Results: There were 405,128 patient hospitalizations included in the cohort. Benzodiazepines were prescribed to 12,484 (3.1%) patients within 7 days of being discharged from hospital. A total of 6,136 (1.5%) patients were identified as new chronic benzodiazepine users. The rate of new chronic benzodiazepine users decreased over the study period from 1.8% in the first year to 1.2% in the final year (P < .001). Multivariate logistic regression found that women, patients admitted to the intensive care unit or nonsurgical wards, those with longer hospital stays, higher overall comorbidity, a prior diagnosis of alcoholism, and those prescribed more medications had significantly elevated adjusted odds ratios for new chronic benzodiazepine users. Older individuals had a lower risk for the primary outcome.Conclusions: New benzodiazepine prescription after hospitalization occurs frequently in older adults and may result in chronic use. A systemic effort to address this risky practice should be considered.