Relationship between Changes in Sedative-Hypnotic Medications Burden and Cognitive Outcomes in Hospitalized Older Adults

Juliana Smichenko, Efrat Gil, Anna Zisberg, Anne Newman

Research output: Contribution to journalArticlepeer-review


Background: Sedative-hypnotic medications (SHMs) are frequently used in hospitalized older patients, despite undesirable effects on cognitive status. Although previous studies found a significant number of patients experience changes in SHM use during hospitalization, it is unclear which pattern of change leads to hospital-associated cognitive decline (HACD). This study tested the association between patterns of SHM change and HACD. Methods: This secondary analysis study included 550 patients age 70+ who were cognitively intact at admission (Short Portable Mental Status Questionnaire [SPMSQ] =8). HACD was defined as at least 1-point decline in SPMSQ between admission and discharge. Changes in sedative burden (SB) before and during hospitalization (average SB of all hospitalization days) were coded using the Drug Burden Index sorting study participants into four groups: without SB (n = 254), without SB changes (n = 132), increased SB (n = 82), and decreased SB (n = 82). Results: Incidence of HACD was 233/550 (42.4%). In multivariate logistic analysis controlling for demographic characteristics, length of stay, severity of acute illness, comorbidity, SB score at home, pain on admission and depression, the odds of HACD were 2.45 (95% CI: 1.16 to 5.13) among participants with increased SB, 2.10 (95% CI: 1.13 to 3.91) among participants without SB changes, compared with participants with decreased SB. Conclusion: Older patients whose SB is increased or does not change are at higher risk for acquired cognitive decline than are those whose SB is reduced. Identifying patients with a potential increase in SB and intervening to reduce it may help to fight HACD.

Original languageEnglish
Pages (from-to)1699-1705
Number of pages7
JournalJournals of Gerontology - Series A Biological Sciences and Medical Sciences
Issue number9
StatePublished - 16 Sep 2020

Bibliographical note

Funding Information:
This work was supported by the Israeli Science Foundation (grant number 565/08); Clalit Health Services (grant number 04-121/2010); and the Israel National Institute for Health Policy Research (grant number 78/2013).

Publisher Copyright:
© 2020 The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved.


  • Cognition
  • Drug burden index
  • Hospitalization
  • Sedative-hypnotic medications

ASJC Scopus subject areas

  • Aging
  • Geriatrics and Gerontology


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