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Sedative-hypnotic use by the elderly: Effects on hospital length of stay and costs

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Abstract

Sedative-hypnotic medications are often used to treat anxiety and sleep disorders, although they may not be used appropriately. Relationships between hospital length of stay (LOS), costs, and levels of sedative-hypnotic use were examined. Charts of 856 elderly patients were reviewed for sedative hypnotic use and categorized into three groups: those whose use exceeded Health Care Financing Administration (HCFA) guidelines, those who used sedative-hypnotic medications but did not exceed HCFA guidelines, and those who did not receive any sedative-hypnotic medications. Patients whose sedative-hypnotic use exceeded guidelines had longer LOS (21.5 exceeding guidelines vs. 12.3 within guidelines vs. 6.7 no use, p≤.001) and higher costs ($29,245 exceeding guidelines vs. $15,219 within guidelines vs. $7,516 no use, p≤.001.) Even after controlling for severity of illness and comorbid conditions, differences in LOS and costs persisted. This study indicates that sedative-hypnotic medications are frequently prescribed to elderly patients, often in doses exceeding proposed guidelines, and are associated with longer hospital stays and higher hospital costs.

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References

  1. Wilcox SM, Himmelstein DU, Woolhandler S: Inappropriate drug prescribing for the community-dwelling elderlyJournal of the American Medical Association 1994; 272:292–296

    Article  Google Scholar 

  2. Gurwitz JH: Suboptimal medication use in the elderly,Journal of the American Medical Association 1994; 272: 316–317.

    Article  PubMed  CAS  Google Scholar 

  3. Hart RP, Colenda CC, Hamer RM: Effects of buspirone and alprazolam on the cognitive performance of normal elderly subjects.American Journal of Psychiatry 1991; 148:73–77.

    PubMed  CAS  Google Scholar 

  4. Cummings RG, Klilneberg RJ: Psychotropics, thiazide diuretics and hip fracture in the elderly.Medical Journal of Australia 1993; 158:414–417.

    Google Scholar 

  5. Ray WA, Fought RL, Decker MD: Psychoactive drugs and the risk of injurious motor vehicle crashes in elderly drivers.American Journal of Epidemiology 1992; 136:873–883.

    Article  PubMed  CAS  Google Scholar 

  6. Zisselman MH, Rovner BW, Kelly KG, et al.: Benzodiazepine utilization in a university hospital.American Journal of Medical Quality 1994; 9(3):138–141.

    PubMed  CAS  Google Scholar 

  7. Health Care Financing Administration:The State Operations Manual. Washington, DC, Government Printing Office, April 1992.

    Google Scholar 

  8. Gonnella JS, Hornbrook MC, Louis DZ: Staging of disease: A case-mix measurement.Journal of the American Medical Association 1984; 251:637–644.

    Article  PubMed  CAS  Google Scholar 

  9. Yuen EJ, Gonnella JS, Louis DZ, et al.: Severity-adjusted differences in hospital utilization by genderAmerican Journal of Medical Quality 1995; 10(2):76–80.

    PubMed  CAS  Google Scholar 

  10. Yuen E, Taroni F, Louis DZ: The Italian case-mix project: Repeated hospitalizations and the quality of care.Clinical Performance and Quality Health Care 1994, 2(3):129–134.

    Google Scholar 

  11. Taroni F, Louis DZ, Yuen EJ: Outcomes management: The Italian case-mix project. In: Casas M, Wiley M (Eds.):Diagnosis Related Groups in Europe: Uses and Perspectives (pp. 97–108). Berlin, Springer-Verlag, 1993.

    Google Scholar 

  12. Umesato Y, Louis DZ, Yuen EJ, et al.: Variation in patient mix and patterns of care: A study at 3 teaching hospitals in Italy, Japan, and the USA.Japan Journal of Medical Informatics November 1993.

  13. Disease Staging, Version 4.3 [software], SysteMetrics, Santa Barbara, California, 1993.

  14. Gonnela JS, Louis DZ, Gozum ME (eds.):Clinical Criteria for Disease Staging. Santa Barbara, CA: Medstat Systems Inc., 1994.

    Google Scholar 

  15. Christoffersson JG, Conklin JE, Gonnella JS: The impact of severity of illness on hospital utilization and outcomes [monograph].InfoPlus 1991; 1–8.

  16. Statistical Analysis Software (SAS) program, version 6.08 for Windows, SAS Institute Inc., Cary, NC, 1994.

    Google Scholar 

  17. Dawson-Saunders B, Trapp RG.Basic and Clinical Biostatistics. Norwalk, CT: Appleton & Lange, 1990.

    Google Scholar 

  18. Drummond MF, Stoddart GW, Torrance GW:Methods for Economic Evaluation of Health Care Programmes. Oxford: Oxford University Press, 1992.

    Google Scholar 

  19. Rush, AJ: Clinical practice guidelines. Good news, bad news, or no news?Archives of General Psychiatry 1993; 50(6):483–490.

    PubMed  CAS  Google Scholar 

  20. American Psychiatric Association Task Force Report.Benzodiazepine Dependence, Toxicity, and Abuse. Washington, DC: American Psychiatric Association, 1990.

  21. Summers RS, Schutte A, Summers B: Benzodiazepine use in a small community hospital.South African Medical Journal 1990; 78:721–725.

    PubMed  CAS  Google Scholar 

  22. Setowing D, Broughton R, McLean WM: A retrospective chart review of hypnotic use.Canadian Journal of Hospital Pharmacy 1985; 38:48–51.

    Google Scholar 

  23. Kelman G, Mayer-Oaks SA, Beers MH, et al.: Benzodiazepine use in older, community-dwelling Southern Californians.Annals of Pharmacotherapy, 1993; 27(4):416–421.

    PubMed  Google Scholar 

  24. Goad JD, Ezell JR: Drug-use evaluation programs for psychotropic medications.American Journal of Hospital Pharmacy 1990; 47:132–136.

    PubMed  CAS  Google Scholar 

  25. Surenkrakumar D, Dunn M, Roberts CJ: Hospital admission and the start of benzodiazepine use.British Medical Journal 1992; 304:881.

    Article  Google Scholar 

  26. U.S. National Center for Health Statistics: National hospital discharge survey, public use tape. Springfield, VA: National Technical Information Service, 1992.

    Google Scholar 

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Authors and Affiliations

  1. Center for Research in Medical Education and Health Care, Jefferon Medical College, 1025 Walnut Street, Suite 119, 19107-5083, Philadelphia, PA

    Elaine J. Yuen M.B.A. (Research Associate)

  2. Division of Geriatric Psychiatry at the Philadelphia Geriatric Center, Temple University School of Medicine, Philadelphia

    Marc H. Zisselman M.D. (director)

  3. Center for Research in Medical Education and Health Care, Jefferon Medical College, Philadelphia

    Daniel Z. Louis M.S. (managing director)

  4. Department of Psychiatry and Human Behavior, Wills Eye Hospital, Philadelphia

    Barry W. Rovner M.D. (director of Geriatric Psychiatry)

Authors
  1. Elaine J. Yuen M.B.A.
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  2. Marc H. Zisselman M.D.
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  3. Daniel Z. Louis M.S.
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  4. Barry W. Rovner M.D.
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Corresponding author

Correspondence to Elaine J. Yuen M.B.A..

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Yuen, E.J., Zisselman, M.H., Louis, D.Z. et al. Sedative-hypnotic use by the elderly: Effects on hospital length of stay and costs. The Journal of Behavioral Health Services & Research 24, 90–97 (1997). https://doi.org/10.1007/BF02790484

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  • DOI: https://doi.org/10.1007/BF02790484

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