Vol.:(0123456789) 1 3 Aging Clinical and Experimental Research https://doi.org/10.1007/s40520-020-01496-1 ORIGINAL ARTICLE Patterns of benzodiazepine administration and prescribing to older adults in U.S. emergency departments Ali Pourmand 1  · Kevin M. Lombardi 1  · Jefrey Roberson 1  · Maryann Mazer‑Amirshahi 2 Received: 6 November 2019 / Accepted: 23 January 2020 © Springer Nature Switzerland AG 2020 Abstract Objectives Benzodiazepine use in older adults is associated with adverse efects including delirium, mechanical falls, fractures, and memory disturbances. In this study we examine the overall utilization of benzodiazepines in the older adult population in U.S. EDs. Methods Data were compiled from the National Hospital Ambulatory Medical Care Survey 2005–2015. Variables were cre- ated to identify all patients over 60 years of age who had and had not been administered benzodiazepines. Bivariate statistical tests were utilized to examine patient demographics, hospital course events and ED/hospital resource allocation and compare older adults administered (in the ED) and prescribed (from the ED) benzodiazepines to those not receiving these agents. Results Between 2005 and 2015 approximately 280 million adults over 60 years of age were seen in EDs throughout the U.S. Overall, benzodiazepines were administered in the ED (only) during 8.5 million visits, and prescribed as a prescription (only) during over 1.3 million visits, with the rate increasing from 2.7% in 2005 to 3.5% in 2015 for benzodiazepines were administered in the ED (only). Overall 42.1% (95% CI 38.8–45.2, p < 0.001) of older adults administered benzodiazepines in the ED were subsequently admitted to the hospital. Rates of co-administration and co-prescription of opioid analgesics were high at 19.0% (95% CI 7.3–19.7) and 17.0% (95% CI 7.9–17.4) for those administered benzodiazepines in the ED, and 21.8% (95% CI 16.3–28.5) and 34.5% (95% CI 27.7–42.0) amongst those prescribed benzodiazepines at discharge. In both cases, these groups were no less likely to be administered opioids in the ED than those not receiving benzodiazepines. A total of 1.1% (95% CI 0.69–1.7, p < 0.001) of older adults administered (in the ED) benzodiazepines were diagnosed with delirium in the ED, compared to 0.0004% who were not (95% CI 0.0038–0.0052). Conclusion Despite the documented risks associated with the utilization of benzodiazepines in older adults, the rate of use in EDs continues to increase. Older adults administered benzodiazepines in the ED were more likely to be admitted to the hospital than those not receiving these agents. Despite the risks associated with co-prescription of benzodiazepines with opioids, those receiving these agents were no less likely to be administered opioids than those who did not. Older adults administered benzodiazepines in the ED were substantially more likely to be diagnosed with delirium in the ED. Keywords Benzodiazepine · Older adult · Emergency department Introduction The American Geriatrics Society (AGS) maintains the Beers Criteria for potentially inappropriate medication (PIM) use in older adults to guide clinicians in considering best prac- tices for prescribing medication to the United States’ (U.S.) aging population [1]. Medications on the Beers list have been demonstrated to be associated with adverse outcomes, such as increased rates of confusion, falls, and overall mortality [2, 3]. Additionally, the second version of the START/STOPP criteria for potentially inappropriate prescribing in older adults identifes and provides guidance for medications associated * Ali Pourmand pourmand@gwu.edu 1 Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, 2120 L St., Washington, DC 20037, USA 2 Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC, USA