212 The Prevalence of Benzodiazepine Use in a Geriatric Emergency Department Population

Abstract

The American Geriatric Society (AGS) has placed both benzodiazepines and non-benzodiazepine GABAA receptor (NGBR) agonists on the Beers list of medications to avoid in patient over 65 years old because of the increased risk of confusion, falls/fractures, and overall mortality. Although traditionally used for ambulatory care settings, emergency departments (ED) are starting to use the Beers criteria as a guide for ED prescribing. Despite existing recommendations, these medications are still administered in this vulnerable age group. The purpose of this study was to evaluate emergency department (ED) patients age 65 years old or older who received a benzodiazepine or NGBR during their ED stay. This was a retrospective observational study conducted at a tertiary care ED from July 1, 2012 to June 30, 2016. Charts from all patients age 65 years old or older were analyzed. We sought to determine the prevalence and pattern of benzodiazepine and NGBR agonist administration while admitted to an emergency department. Descriptive statistics are reported for patients who received these medications. There were 28,356 patients over the age of 65 years old presenting to our ED from July 1, 2012 to June 30, 2016. A total of 1750 (6.2%) patients received a benzodiazepine or NBGR agonist during their ED stay. Of these patients, 784 were males (45%) and 966 were females (55%). Most patients (n=989, 57%) were between 65 years old and 74 years old, followed by 541 (31%) between 75-84 years old. 220 (13%) patients were 85 years old or older. The most frequently administered medication was lorazepam (n=820, 47%), followed by diazepam (n=534, 31%). Zolpidem was given to 265 patients (15%). Chlordiazepoxide was the least frequently administered (n=17). 101 (6%) patients received more than one type of benzodiazepine. The five most common chief complaints in which benzodiazepines or NBGR agonists were used were shortness of breath (n=176, 10%) neck/back pain (n=175, 10%), dizziness/vertigo (n=129, 7%), abdominal pain (n=125, 7%), and chest pain (n=100, 6%). A minority of patients who received these medications presented with a psychiatric chief complaint (24 patients with suicidal ideations; 17 patients with anxiety). Only 10 patients received benzodiazepines for an alcohol-related problem; and 21 patients received benzodiazepines for seizures. 60 patients obtained a psychiatric evaluation during their ED stay. 1026 (58%) patients were admitted to the hospital or transferred to another acute care hospital. 712 (41%) patients were discharged, and 12 patients left against medical advice. Although several major psychiatric and geriatric organizations advise against the use of benzodiazepines and NBGR agonists in patient older than 65 years old, these medications continue to be used for a variety of conditions. Optimizing medication use to treat conditions in the ED while avoiding adverse drug events is often challenging, particularly in the older adult who is already at risk for drug-related problems. Although benzodiazepine administration may at times be indicated, further education is warranted. Providing emergency physicians with evidence-based alternatives to benzodiazepine use and designing ED specific guidelines need to be explored.