Hospital discharge sedatives linked to more falls, readmissions and deaths in older adults

by Canadian Medical Association Journal

edited by Sadie Harley, reviewed by Robert Egan

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Older adults discharged from hospital with a new prescription for a sedative, especially a benzodiazepine or antipsychotic, are at increased risk of falls and other negative consequences, according to new research published in the Canadian Medical Association Journal.

"Our results showed that discharging older adults after an acute care hospital stay with a new prescription for these medications was associated with an increased hazard of falls requiring medical attention, further need for acute hospital care, and death in the 30 days after hospital discharge, whereas individuals with prior exposure did not experience the same increased hazards," writes Dr. Lisa Burry, clinician scientist at Mount Sinai Hospital, Sinai Health and University of Toronto, Toronto, Ontario, with co-authors.

Falls are a major public health burden and affect older adults in particular. Sedatives and antipsychotics are associated with adverse events, and clinical guidance discourages prescribing these potentially inappropriate medications for older adults.

The study of more than 1.86 million adults age 66 and older aimed to understand prescribing patterns to inform future discharge prescribing. Based on ICES data, it looked at all patients discharged from hospital between April 2003 and August 2023.

In total, 13% (246,440) filled at least one prescription for any sedative within seven days of discharge, and about one-third (76,335) of them had not filled a prescription for a sedative within the six-month period before hospitalization. The risk of falls was 20% higher in people with a new sedative prescription, and the risk of an emergency department visit, readmission and death within 30 days was also increased.

"Although the overall absolute magnitude of the risk of adverse events identified was modest from a population perspective, the effects on patients and their families are clinically and socially important," write the authors. "Moreover, given the volume of hospital admissions among older adults and the aging population, a modest increase in risk translates into a large impact on the health care system."

The authors suggest caution when prescribing these medications at hospital discharge, ensuring medical follow-up one to two weeks after discharge to monitor patients, continue risk assessment and review the need for the prescription.

"Given the identified associations, clinicians must consider whether new sedative prescriptions are essential or can be deprescribed or de-escalated before or shortly after hospital discharge. When ongoing sedative use is required, community support, such as falls or mobility assessments, and ongoing medication reviews may help mitigate risks," the authors conclude.

Publication details

Association between sedative prescriptions after hospital discharge and falls and other adverse events in older adults: a population-based cohort study, Canadian Medical Association Journal (2026). DOI: 10.1503/cmaj.251965 www.cmaj.ca/lookup/doi/10.1503/cmaj.251965

Journal information: Canadian Medical Association Journal

Key medical concepts

BenzodiazepinesAntipsychotic AgentsFallsMortalityHospital Readmission, Unplanned

Clinical categories

Geriatric palliative careHospital medicineHealthy agingClinical pharmacologyCommon illnesses & Prevention Provided by Canadian Medical Association Journal Who's behind this story?

Sadie Harley

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Robert Egan

Bachelor's in mathematical biology, Master's in creative writing. Well-traveled with unique perspectives on science and language. Full profile →

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