If you or someone you love has recently been discharged from hospital with a new prescription for a sedative or antipsychotic, new research suggests there is a conversation worth having with your doctor before you fill it.

A major study of more than 1.86 million adults aged 66 and over, published this week in the Canadian Medical Association Journal, has found that older adults who leave hospital with a new sedative prescription they were not previously taking face a 20 per cent higher risk of falls requiring medical attention – along with increased risks of emergency department visits, hospital readmission and death within 30 days of discharge.

Critically, patients who were already taking sedatives before hospitalisation did not experience the same increased risks. It is the newness of the prescription – and the vulnerability of the transition home – that appears to be the danger.

What the research found

The study, led by Dr Lisa Burry, a clinician scientist at Mount Sinai Hospital and the University of Toronto, analysed hospital discharge records spanning 20 years, from April 2003 to August 2023.

Of all patients discharged, 13 per cent – more than 246,000 people – filled at least one prescription for a sedative within seven days of leaving hospital. Roughly one-third of those patients – approximately 76,000 people – had not filled a sedative prescription in the six months before their hospitalisation. In other words, the medication was new.

It was this group – patients being introduced to sedatives for the first time during or immediately after a hospital stay – who experienced the highest risk of adverse events. Falls requiring medical attention were 20 per cent more likely. Emergency department visits, readmission and death within 30 days were also elevated.

Why hospital discharge is such a vulnerable moment

The findings highlight something that families and carers of older Australians know instinctively but that the health system does not always account for: the period immediately after coming home from hospital is one of the most dangerous times for an older person.

Patients are often weakened from their hospital stay. They may be managing pain, adjusting to mobility changes and navigating a new or altered medication regime – sometimes with limited follow-up from their GP in the first days after discharge.

Adding a sedative or antipsychotic to that mix – particularly one the patient has never taken before – introduces drowsiness, impaired balance, confusion and slower reaction times at precisely the moment when the risk of falls is already elevated.

The medications most commonly involved in the prescribing patterns identified by the study included benzodiazepines and antipsychotics, both of which are already recognised by clinical guidelines as potentially inappropriate for older adults and associated with increased fall risk.

The scale of the problem

The researchers acknowledge that the absolute increase in risk for any individual patient is modest. But they are clear about what that means at a population level.

“Given the volume of hospital admissions among older adults and the ageing population, a modest increase in risk translates into a large impact on the health care system,” the authors write.

In Australia, falls are the leading cause of injury-related hospitalisation for people aged 65 and over. More than 130,000 Australians are hospitalised for falls each year, and the consequences – hip fractures, head injuries, loss of independence, admission to residential care – are among the most significant and costly health outcomes in the country.

Any factor that increases fall risk by 20 per cent in a population this large is not modest. It is a public health concern.

What families should do

The researchers’ recommendations are practical and worth acting on.

First, before leaving hospital, ask the discharging doctor whether any new medications have been prescribed – specifically sedatives, sleeping tablets, antipsychotics or benzodiazepines. If so, ask whether the medication is essential or whether a non-pharmacological alternative could be considered.

Second, ensure a GP follow-up appointment is scheduled within one to two weeks of discharge. This is the window in which new medications should be reviewed, side effects monitored and the ongoing need for the prescription reassessed.

Third, if a new sedative is genuinely required, ask about community support services including falls and mobility assessments that can help mitigate the risk during the adjustment period.

Fourth, watch for warning signs in the first 30 days after discharge – particularly drowsiness, unsteadiness, confusion and changes in balance or gait. These may be side effects of the new medication rather than symptoms of the original condition.

“Given the identified associations, clinicians must consider whether new sedative prescriptions are essential or can be deprescribed or de-escalated before or shortly after hospital discharge,” the authors conclude. “When ongoing sedative use is required, community support and ongoing medication reviews may help mitigate risks.”

The one question worth asking

For any older Australian leaving hospital – or any family member collecting them – one simple question is worth asking before walking out the door: “Has anything new been prescribed, and do we still need it when we get home?”

It is a small question. This research suggests the answer could make a significant difference.