Benzodiazepine Use and Deprescribing in Belgian Nursing Homes: Results from theCOME‐ONStudy

Abstract

BACKGROUND/OBJECTIVES To describe the use and deprescribing of benzodiazepine receptor agonists (BZRAs) among nursing home residents (NHRs), to evaluate appropriateness of use and to identify factors associated with BZRA use and deprescribing. DESIGN Posthoc analysis of the Collaborative Approach to Optimize Medication Use for Older People in Nursing Homes (COME‐ON) study, a cluster controlled trial that evaluated the impact of a complex intervention on potentially inappropriate prescriptions (PIPs) in nursing homes (NHs). SETTING A total of 54 NHs in Belgium. PARTICIPANTS A total of 797 NHRs included in the study who had complete medical, clinical, and medication information at baseline and at the end of the study (month 15). MEASUREMENTS Data were recorded by participating healthcare professionals. Reasons why BZRA use was considered as PIPs were assessed using the 2019 American Geriatrics Society Beers Criteria® and the Screening Tool of Older Persons’ Prescriptions (STOPP) criteria, version 2. Deprescribing included complete cessation or decreased daily dose. We identified factors at the NHR, prescriber, and NH levels associated with BZRA use and BZRA deprescribing using multivariable binary and multinomial logistic regression, respectively. RESULTS At baseline, 418 (52.4%) NHRs were taking a BZRA. The use of BZRA for longer than 4 weeks, with two or more other central nervous system active drugs, and in patients with delirium, cognitive impairment, falls, or fractures was found in more than 67% of BZRA users. Eight NHR‐related variables and two prescriber‐related variables were associated with regular BZRA use. Deprescribing occurred in 28.1% of BZRA users (32.9% in the intervention group and 22.1% in the control group). In addition to four other factors, dementia (odds ratio [OR] = 2.35; 95% confidence interval [CI] = [1.45–3.83]) and intervention group (OR = 1.74; 95% CI = 1.07–2.87) were associated with deprescribing. CONCLUSION Use of BZRAs was highly prevalent, and reasons to consider it as PIP were frequent. Deprescribing occurred in one‐fourth of NHRs, which is encouraging. Future interventions should focus on specific aspects of PIPs (ie, indication, duration, drug‐drug and drug‐disease interactions) as well as on nondementia patients.

Interventions to optimize medication use in nursing homes: a narrative review

“…In a study with 2651 French NHRs receiving an antidepressant, PIP (with regard to indication, drug class, duplication and monitoring) was found in 38.4% of NHRs [ 35 ]. In a Belgian study with 418 NHRs taking a BZRA, 98% of NHRs received the BZRA for more than 4 weeks, and drug–disease and drug–drug interactions were found in two-thirds of users overall [ 36 ]. In both studies, dementia was associated with less PIP.…”

What Makes Deprescription of Psychotropic Drugs in Nursing Home Residents with Dementia so Challenging? A Qualitative Systematic Review of Barriers and Facilitators

“…There is strong evidence that suggests, however, that antipsychotics have modest efficacy and are associated with cerebrovascular events and death [7][8][9]. Despite a relatively high use of benzodiazepines [10][11][12][13], evidence supporting clinical efficacy is very limited [14][15][16] and may be associated with a higher risk of falls, cognitive impairment, and sedation [17,18]. Guidelines advise against a range of antidepressants, especially those with anticholinergic effects, because of side effects and adverse effects [19].…”

Trends in benzodiazepine receptor agonists use and associated factors in the Belgian general older population: analysis of the Belgian health interview survey data

“… 18 – 20 In the Belgian nursing home setting, a recent study by Evrard et al showed that a history of fall in the past 3 months, chronic obstructive pulmonary disease, polypharmacy, insomnia, and antidepressant use were factors associated with BZRA use. 17 On the contrary, dementia and trazodone use were factors negatively associated with BZRA use. 17 However, no study has been conducted to identify factors associated with BZRA use in older people from the general Belgian older population.…”

“… 17 On the contrary, dementia and trazodone use were factors negatively associated with BZRA use. 17 However, no study has been conducted to identify factors associated with BZRA use in older people from the general Belgian older population.…”

“…15 However, these reports did not focus specifically on BZRA. If previous studies estimated the BZRA use prevalence to 52–53% of the Belgian nursing home residents, 16 , 17 to our knowledge, no study has yet assessed BZRA use prevalence in the general older population and its evolution over time.…”