Differences in Benzodiazepine Receptor Agonist Use in Rural and Urban Older Adults

Abstract

BackgroundOlder adults are especially susceptible to adverse consequences of potentially inappropriate medications (PIMs), such as benzodiazepine receptor agonists (BZDRAs), due to age-related pharmacokinetic and pharmacodynamic changes. Although some risk factors for BZDRA use in older adults have been identified, the role of rural versus urban residence is less clear.ObjectiveTo describe BZDRA use in rural versus urban older adults using pharmaceutical claims from Pennsylvania’s Pharmaceutical Assistance Contract for the Elderly (PACE) program.MethodsThe sample consisted of older adults enrolled in Pennsylvania’s Healthy Steps for Older Adults and participated in Pennsylvania’s PACE program. Independent sample t tests and contingency tables were used to examine residence differences. Multivariate binary logistic modeling was performed.ResultsThe total sample (N = 426) was 305 (71.6 %) urban-dwelling adults and 121 (28.4 %) rural-dwelling adults. Rural participants were more likely to be male, white, married, and have less than a high school education compared with urban participants (p <.01). Specifically, 25 % of rural-dwelling adults received a BZDRA compared with 15 % of urban-dwelling adults (p = 0.02). Three variables reached statistical significance for predicting BZDRA use in a multivariate model: rural residence (OR 2.58, 95 % CI 1.39–4.79), history of anxiety/depression (OR 4.20, 95 % CI 2.39–7.46), and number of medications (OR 1.11, 95 % CI 1.02–1.21).ConclusionsBZDRA prescription differences in older, rural-dwelling adults further highlights the need for geriatric and mental health specialists to provide specialized care to this population. Rural healthcare professionals may be less aware of PIMs for older adults, and initiatives to support geriatric services and provide education for existing providers may be beneficial.

Factors associated with potentially inappropriate medication use in community-dwelling older adults in the United States: a systematic review†

“…The overall risk of bias was low in 18 studies and moderate in four studies (Table ) . The deficiencies in the studies that had more than a low risk of bias were potential biases due to confounding, missing information about participants at baseline, and low or unreported response rates in surveys.…”

“…Twenty‐two studies evaluated determinants of PIM use in community‐dwelling and ambulatory clinic patients . Most studies were either cross‐sectional analyses of claims data or analyses of large nationally representative surveys such as the Medical Expenditure Panel Survey (MEPS) or the National Ambulatory Medical Care Survey (NAMCS) (Tables and ).…”

“…Most studies used a broad definition, such as the Beers criteria, to define PIM but eight included studies used a more restrictive definition of PIM such as anticholinergics or potentially inappropriate medications in patients with cognitive disorders (Table ) . Fourteen of the included studies examined actual dispensing data through claims, pharmacy contact or review of actual pill bottles …”

“…Nineteen studies evaluated patient factors contributing to PIM use in community‐dwelling adults or those attending ambulatory clinics (Table ). Seventeen used multivariable regression, adjusting for a combination of patient factors, patient and system factors or patient system and clinician factors . Two studies used bivariate analysis …”

“…Being a woman was positively associated with PIM use in 10 studies Among the six studies which did not report a statistically significant association between sex and PIM use were two that used bivariate instead of multivariate analysis, a small ( n = 82) study limited to Chinese American older adults in a single city, and two that had a sample that was more than 80% women . However, one study using nationally representative MEPS data did not report a statistically significant association with sex and PIM use when their final multivariate model was adjusted for number of medications …”