New sedatives after discharge may raise fall risk in older adults

Clinical Takeaway: Before sending an older adult home on a new benzodiazepine, antipsychotic, trazodone, or mirtazapine, confirm the indication, dose, duration, and follow-up plan—and consider deprescribing or de-escalation before or soon after discharge.

Hospital discharge is a high-risk transition, and a new sedative prescription may add avoidable risk for older adults who were not previously using these medications.

In this population-based cohort study, researchers analyzed 1,868,484 adults aged 66 years or older discharged alive from acute care hospitals in Ontario between 2003 and 2023. Overall, 13.2% filled a sedative prescription within 7 days of discharge; among these patients, 31.0% had not filled a sedative prescription in the prior 6 months.

Within 30 days, 1.6% of patients had a fall requiring medical attention, 21.3% had an ED visit, 12.4% were readmitted, and 3.8% died. Among patients who were sedative-naive before hospitalization, filling a new sedative prescription after discharge was associated with about 20% higher hazards of falls, ED visits, and readmissions, and a 78% higher hazard of death. Patients with prior sedative exposure did not show the same increased hazards for falls, ED visits, or readmission, although death risk was modestly higher.

Risk varied by drug class. New benzodiazepine prescriptions showed the most consistent signal, with about 25% higher fall hazard and higher hazards of ED visits, readmission, and death among benzodiazepine-naive patients. New antipsychotic prescriptions were linked to higher hazards of falls and death. Unexpectedly, trazodone or mirtazapine prescriptions were associated with lower fall hazard, a finding the authors said needs confirmation.

“Although the overall absolute magnitude of the risk of adverse events identified was modest,” the authors wrote, “a modest increase in risk translates into a large impact on the health care system.” They recommended structured medication review, fall-risk assessment, and follow-up within 1 to 2 weeks when ongoing sedative use is necessary.

Source: Burry LD, et al. 2026 June 29. CMAJ. Association between sedative prescriptions after hospital discharge and falls and other adverse events in older adults: a population-based cohort study