CNS-active medication use and adverse health outcomes among Thai older adults: a population-based retrospective study

Central nervous system-active (CNS-active) medications should be avoided or used with caution in the older adults because of their associated risks. This study aimed to assess the prevalence of CNS-active medication use among Thai older adults and to evaluate associated health outcomes. We conducted a retrospective study among adults aged 60 years and older in Lampang Province, Thailand. Medical records from January to December 2021 were reviewed to identify prescriptions of CNS-active medication classified as potentially inappropriate medications according to the Beers Criteria. Adverse health outcomes, including falls, hip fractures, hospital admissions, and mortality, were examined. Among 170,709 older adults included in the analysis, 17.30% (n = 29,533) received at least one CNS-active medication. Benzodiazepines were the most commonly prescribed CNS-active medications, with lorazepam being the most frequently used agent. After adjustment for potential confounders, CNS-active medication use was associated with a higher risk of falls (adjusted prevalence ratio [aPR], 1.79; 95% CI, 1.64–1.96; p < 0.001), hospital admission (aPR, 1.82; 95% CI, 1.76–1.83; p < 0.001), and all-cause mortality (aPR, 1.08; 95% CI, 1.00–1.16; p 0.049) compared with non-users. A trend toward an increased risk of hip fracture was also observed (aPR, 1.19; 95% CI, 0.97–1.46; p 0.093). These findings underscore the need for more cautious prescribing practices, enhanced medication review, and targeted interventions to minimize the use of high-risk CNS-active medications in this vulnerable population.