Risk factors for benzodiazepine deprescribing failure after discharge from an acute geriatric ward: A retrospective cohort study.

BACKGROUND: Benzodiazepines and related agents (BZRAs) are widely used in older adults and are associated with adverse outcomes. Older adults are particularly vulnerable to inappropriate prescribing, and care transitions represent critical periods for medication changes. Hospitalisation offers an opportunity to initiate deprescribing, but determinants of post-discharge deprescribing failure remain poorly understood in geriatric populations. METHODS: We conducted a single-centre retrospective cohort study in an acute geriatric ward of a tertiary university hospital including patients aged ≥75 years with BZRA prescriptions at admission. We explored clinical and organisational factors associated with failure to maintain deprescribing. Deprescribing failure was defined as an increase in diazepam-equivalent dose between hospital discharge and the first post-discharge prescription within 12 months. Multivariable logistic regression was performed. RESULTS: Among 155 included patients, deprescribing was initiated in 95 (61.3%). Post-discharge prescription data were available for 79 patients, of whom 21 (26.6%) experienced deprescribing failure. Medication self-management was the only variable found to be associated with failure in this exploratory analysis (OR 4.86, 95% CI 1.16-20.28), whereas no other clinical or treatment-related variables were significantly associated. CONCLUSIONS: Deprescribing of BZRAs in older adults is frequently initiated during hospitalisation but often reversed after discharge. These findings suggest that autonomy and care transitions may play a role in shaping medication trajectories during ageing and warrant confirmation in larger prospective studies.