International Comparison of Benzodiazepine Prescription for Older Adults in Acute Care Hospitals

Dear Editor, Benzodiazepines (BZD) are harmful to older adults.They are associated with increased mortality [1], and increased hospitalization-associated complications (HAC), such as delirium [2] and falls [3].Despite these known adverse events, BZD use remains prevalent in older adults and represents a potentially modifiable risk factor for adverse outcomes.Although acute care hospitals are at particularly high risk for HAC from BZD usage, there has been little systematic research into the prescribing practices of BZD.The purpose of this study was to investigate the current status of BZD prescriptions, including Z-drugs (ZD), in acute care hospitals in the United States and Japan, where guidelines recommend reducing and discontinuing BZD [4,5], and to conduct an international comparison.We conducted a retrospective, observational, cross-sectional study.Data collection was conducted at two high-acute care university hospitals: The University of North Carolina at Chapel Hill School of Medicine (UNC) in Chapel Hill, NC, USA and Nagoya University Hospital (NUH) in Nagoya, Aichi, Japan.Inclusion criteria were patients aged 65 years or older who were admitted to an internal medicine ward, including geriatrics, at UNC or NUH, between January 1, 2023, and December 31, 2024.Patients admitted to the oncology or intensive care units were excluded.Medical information on medications administered during hospital admission and age was collected and analyzed.Prescription rates of BZD and ZD were compared using the Chi-square test.