Abstract
Abstract
Background
The use of benzodiazepines (BZDs) in older population is often accompanied by drug-related complications. Inappropriate BZD use significantly alters older adults’ clinical and functional status. This study compares the prevalence, prescribing patterns and factors associated with BZD use in community-dwelling older patients in 7 European countries.
Methods
International, cross-sectional study was conducted in community-dwelling older adults (65 +) in the Czech Republic, Serbia, Estonia, Bulgaria, Croatia, Turkey, and Spain between Feb2019 and Mar2020. Structured and standardized questionnaire based on interRAI assessment scales was applied. Logistic regression was used to evaluate factors associated with BZD use.
Results
Out of 2,865 older patients (mean age 73.2 years ± 6.8, 61.2% women) 14.9% were BZD users. The highest prevalence of BZD use was identified in Croatia (35.5%), Spain (33.5%) and Serbia (31.3%). The most frequently prescribed BZDs were diazepam (27.9% of 426 BZD users), alprazolam (23.7%), bromazepam (22.8%) and lorazepam (16.7%). Independent factors associated with BZD use were female gender (OR 1.58, 95%CI 1.19–2.10), hyperpolypharmacy (OR 1.97, 95%CI 1.22–3.16), anxiety (OR 4.26, 95%CI 2.86–6.38), sleeping problems (OR 4.47, 95%CI 3.38–5.92), depression (OR 1.95, 95%CI 1.29–2.95), repetitive anxious complaints (OR 1.77, 95%CI 1.29–2.42), problems with syncope (OR 1.78, 95%CI 1.03–3.06), and loss of appetite (OR 0.60, 95%CI 0.38–0.94). In comparison to Croatia, residing in other countries was associated with lower odds of BZD use (ORs varied from 0.49 (95%CI 0.32–0.75) in Spain to 0.01 (95%CI 0.00–0.03) in Turkey), excluding Serbia (OR 1.11, 95%CI 0.79–1.56).
Conclusions
Despite well-known negative effects, BZDs are still frequently prescribed in older outpatient population in European countries. Principles of safer geriatric prescribing and effective deprescribing strategies should be individually applied in older BZD users.
Publisher
Springer Science and Business Media LLC
Reference65 articles.
1. McIntosh B, Clark M, Spry C. Benzodiazepines in older adults: A review of clinical effectiveness, cost-effectiveness, and guidelines. Ottawa: Canadian Agency for Drugs and Technologies in Health; 2011 (Rapid Response Report: Peer-Reviewed Summary with Critical Appraisal). https://www.ncbi.nlm.nih.gov/books/NBK174561/pdf/Bookshelf_NBK174561.pdf. Accessed 22 Dec 2022.
2. Danish Health and Medicines Authority. Effective effort against the excessive use of benzodiazepines in Denmark. http://www.dkma.dk/en/topics/statistics-prices-and-reimbursement/statistics-and-analyses/analyses/consumptionanalyses/effective-effort-against-the-excessive-u--in-denmark. Accessed 22 Dec 2022.
3. Medicines and Healthcare products Regulatory Agency (MHRA). Addiction to benzodiazepines and codeine: supporting safer use. July 2011. http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON123123. Accessed 22 Dec 2022.
4. Haute Autorité de Santé. Modalités d’arrêt des benzodiazépines et médicaments apparentés chez le patient âgé. 2007. http://www.has-sante.fr/portail/jcms/c_601509/modalites-d-arret-des-benzodiazepines-et-medicaments-apparentes-chez-le-patient-age?xtmc=benzodiaz%E9pines&xtcr=4. Accessed 22 Dec 2022.
5. Bachhuber MA, Hennessy S, Cunningham CO, et al. Increasing benzodiazepine prescriptions and overdose mortality in the United States, 1996–2013. Am J Public Health. 2016;106:686–8. https://doi.org/10.2105/AJPH.2016.303061.