Benzodiazepine exposure and 6-month mortality in older adults post-hospitalization: time to consider deprescribing?

BACKGROUND: Benzodiazepines (BZDs) are commonly used in older populations despite their association with multiple adverse outcomes. However, the impact of continuing versus deprescribing BZDs during hospitalization on short-term mortality after discharge remains uncertain. This study aims to evaluate the association of BZD-use at hospital discharge with 6-month mortality and explore whether in-hospital deprescribing modifies mortality risk. METHODS: This is a retrospective analysis of prospectively collected data from patients (aged 66-101 years) consecutively admitted to an Acute Geriatric Unit. Upon admission, all patients underwent a Comprehensive Geriatric Assessment, including functional status, comorbidities, and medications review. A multivariable Cox regression model was used to evaluate the relationship between 6-month mortality and BZD prescription at hospital discharge (BZD nonusers, BZD at discharge, and BZD deprescribed). RESULTS: Overall, 1375 patients (median age: 85.5 [IQR: 48-77, 55% females]) were included. Following therapeutic reconciliation, the BZD at discharge group was younger (p = .029), had lower frailty (p = .031), cognitive decline (p = .043), and in-hospital delirium (p < .001) prevalence than the BZD nonusers and BZD deprescribed groups. The BZD at discharge group (n = 130) showed a higher risk of all-cause 6-month mortality compared to BZD nonusers (n = 1066) (HR: 1.64; 95% CI: 1.14-2.37). Conversely, patients in whom BZDs were deprescribed during hospitalization (n = 179) exhibited a similar mortality risk as nonusers (HR: 0.97; 95% CI: 0.68-1.39). CONCLUSIONS: BZDs prescription on hospital discharge was associated with an increased risk of 6-month mortality, whereas deprescription may mitigate this excess risk. Our data suggest that hospitalization may represent an opportunity to safely deprescribe BZDs in a controlled setting.