Benzodiazepine Use and Physical Disability in Community‐Dwelling Older Adults

Gray, Shelly L.; LaCroix, Andrea Z.; Hanlon, Joseph T.; Penninx, Brenda W. J. H.; Blough, David K.; Leveille, Suzanne G.; Artz, Margaret B.; Guralnik, Jack M.; Buchner, D M

doi:10.1111/j.1532-5415.2005.00571.x

Cited by 115 publications

(87 citation statements)

References 45 publications

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“…5 Patients with opioid use disorders have a higher risk of overdose death-both suicide and non-suicide-when taking benzodiazepines. 6,7,35 Senior patients are particularly vulnerable, because benzodiazepines are associated with falls, [36][37][38][39] hip fractures, 12 delirium, 10,11 disability, 13 dementia, 14,15 and motor vehicle accidents. 40 Osteoporosis has been linked to fractures alongside benzodiazepine prescriptions in The referent for odds ratios for diagnoses and other prescriptions is patients who did not have that diagnosis or prescription patients at risk of falls, although no direct relationship between osteoporosis and benzodiazepine prescriptions has been described.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 Benzodiazepines may also be linked to cancer risk and to exacerbation of obstructive sleep apnea (OSA) severity. 8,9 In the elderly, benzodiazepines are associated with delirium in the hospital 10,11 and with hip fractures, 12 disability, 13 and dementia 14,15 in the community. Although benzodiazepines are frequently prescribed by primary care physicians (PCPs), 16 few studies have described in detail which primary care patients receive benzodiazepine prescriptions.…”

Section: Introductionmentioning

confidence: 99%

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Benzodiazepines are Prescribed More Frequently to Patients Already at Risk for Benzodiazepine-Related Adverse Events in Primary Care

et al. 2016

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BACKGROUND: Benzodiazepine use is associated with adverse drug events and higher mortality. Known risk factors for benzodiazepine-related adverse events include lung disease, substance use, and vulnerability to fracture. OBJECTIVE: To determine whether benzodiazepine prescribing is associated with risk factors for adverse outcomes. DESIGN: Longitudinal cohort study between July 1, 2011, and June 30, 2012. PARTICIPANTS: Patients who visited hospital-and community-based practices in a primary care practicebased research network. MAIN MEASURES:Odds ratio of having a target medical diagnosis for patients who received standard and highdose benzodiazepine prescriptions; rates per 100 patients for outpatient and emergency department visits and hospitalizations. KEY RESULTS: Among 65,912 patients, clinicians prescribed at least one benzodiazepine to 15 % (9821). Of benzodiazepine recipients, 5 % received high doses. Compared to non-recipients, benzodiazepine recipients were more likely to have diagnoses of depression (OR, 2.7; 95 % CI, 2.6-2.9), substance abuse (OR, 2.2; 95 % CI, 1.9-2.5), tobacco use (OR, 1.7; 95 % CI, 1.5-1.8), osteoporosis (OR, 1.6; 95 % CI, 1.5-1.7), chronic obstructive pulmonary disease (OR, 1.6; 95 % CI, 1.5-1.7), alcohol abuse (OR, 1.5; 95 % CI, 1.3-1.7), sleep apnea (OR, 1.5; 95 % CI, 1.3-1.6), and asthma (OR, 1.5; 95 % CI, 1.4-1.5). Compared to low-dose benzodiazepine recipients, high-dose benzodiazepine recipients were even more likely to have certain medical diagnoses: substance abuse (OR, 7.5; 95 % CI, 5.5-10.1), alcohol abuse (OR, 3.2; 95 % CI, 2.2-4.5), tobacco use (OR, 2.7; 95 % CI, 2.1-3.5), and chronic obstructive pulmonary disease (OR, 1.5; 95 % CI, 1.2-1.9).Benzodiazepine recipients had more primary care visits per 100 patients (408 vs. 323), specialist outpatient visits (815 vs. 578), emergency department visits (47 vs. 29), and hospitalizations (26 vs. 15; p < .001 for all comparisons). CONCLUSIONS: Clinicians prescribed benzodiazepines and high-dose benzodiazepines more frequently to patients at higher risk for benzodiazepine-related adverse events. Benzodiazepine prescribing was associated with increased healthcare utilization.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Benzodiazepines are Prescribed More Frequently to Patients Already at Risk for Benzodiazepine-Related Adverse Events in Primary Care

et al. 2016

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“…Associations between benzodiazepines use and onset of mobility and ADL limitations have previously been found (Gray et al, 2006) and benzodiazepine use in the past year has been shown to be associated with both ADL and IADL limitations (Ried et al, 1998). Although many possible confounding variables such as antidepressant use have been taken into account, the observed associations for mobility and IADL limitations are likely to be more strongly related to underlying symptoms associated with anxiolytic use rather than with use itself: an independent effect of anxiolytic use on activity limitations cannot be ruled out but the mechanisms involved are likely to be complex, especially over a 7-year follow-up period.…”

Section: Other Confounding and Mediating Effectsmentioning

confidence: 99%

“…Benzodiazepines are the most frequently prescribed anxiolytic medication in older adults, of which approximately half are long half-life agents (Gray et al, 2006). However, they are associated with a number of adverse risks, especially those with a long half-life, including cognitive impairment, psychomotor impairment, excessive daytime sedation, instability of gait, falls, and hip fractures (Gray et al, 2002;Gray et al, 2006;Ried et al, 1998).…”

Section: Introductionmentioning

confidence: 99%

Anxiety symptoms and disorder predict activity limitations in the elderly

Norton

Ancelin

Stewart

et al. 2012

Journal of Affective Disorders

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“…Numerous studies have associated benzodiazepine use in older people with an increased risk of falls, hip fractures, injury, car crashes, physical disability and increased mortality. [57][58][59][60][61][62][63][64] Some of these studies may have underestimated the association as benzodiazepines are frequently found in the serum and/or urine of older people with a hip fracture who deny having taken them. 65 Benzodiazepine use has been associated with tolerance, resulting in the use of increasing doses although there is some evidence that tolerance may also develop to adverse effects such as falls.…”

Section: Benzodiazepinesmentioning

confidence: 99%

Managing Insomnia in Older People

Woodward

2007

Pharmacy Practice and Res

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Although insomnia is a common problem in older people, there have been few therapeutic advances in the last decade. Benzodiazepines continue to be overused and the newer benzodiazepine-like drugs (e.g. zopiclone) are proving to be no more effective and have their own risk of adverse effects. Nonpharmacological management remains the preferred option, but is poorly taught and infrequently adhered to, especially in hospital and residential care settings. Older people themselves often request drugs. Progress towards improved management of insomnia will require a significant shift in knowledge and attitudes in both health professionals and the community. INTRODUCTIONSleep is vital for health and quality of life and older people frequently find sleep elusive. Poor sleep interacts with many medical and psychiatric conditions which are more common in older age, thus exacerbating their morbidity. It would therefore be expected that there have been ongoing and major developments in the understanding and management of insomnia in older people. While some progress has been made there is still a long way to travel before older people with insomnia have a good understanding of sleep disorders, are well assessed, are correctly managed, and participate as informed partners in an effective management program.Changes in the amount and pattern of sleep in older people include spending more time in bed, but less time asleep and easy arousal from sleep, when compared with younger people. 1-5 Average total sleep time actually increases slightly after 65 years of age. 6 Time from retiring to bed and sleep onset increases with age, and there are changes in the quality of sleep. Slow wave (deeper, restorative) sleep reduces with age, there is increased fragmentation of sleep and rapid eye movement (REM) sleep is reduced. 7,8 These changes in sleep and wakefulness with age are in the direction of impaired sleep maintenance and depth. This increased night-time wakefulness is mirrored by increases in daytime fatigue, daytime napping and the likelihood of falling asleep during the day. Advancing age is associated with a tendency to fall asleep by day and to sleep less well at night. These age-related changes in sleep appear to be partly dependent on medical and psychiatric disorders, rather than universal features of normal ageing. 9,10

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Benzodiazepine Use and Physical Disability in Community‐Dwelling Older Adults

Abstract: Older adults taking benzodiazepines have a greater risk for incident mobility and ADL disability. Use of short-acting agents does not appear to confer any safety benefits over long-acting agents.

Cited by 115 publications

References 45 publications

Benzodiazepines are Prescribed More Frequently to Patients Already at Risk for Benzodiazepine-Related Adverse Events in Primary Care

Benzodiazepines are Prescribed More Frequently to Patients Already at Risk for Benzodiazepine-Related Adverse Events in Primary Care

Anxiety symptoms and disorder predict activity limitations in the elderly

Managing Insomnia in Older People

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