Discontinuation of Chronic Benzodiazepine Use Among Adults in the United States

Gerlach, Lauren B.; Strominger, Julie; Kim, Hyungjin Myra; Maust, Donovan T.

doi:10.1007/s11606-019-05098-0

Cited by 13 publications

(22 citation statements)

References 33 publications

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“…Our ndings on discontinuation were higher than owing to voluntary cessation in outpatient care due to the deprescribing culture among the physicians and awareness campaigns in the hospital. In a recent retrospective study performed in the United States, spontaneous discontinuation of chronic BZD use in adults aged 18 years and older was only 13.4% at the end of the following year which is much lower than in our study [33]. The discontinuation rate of the control group in the EMPOWER trial was 5% [34].…”

Section: Discussioncontrasting

confidence: 72%

“…Based on previous report, it might be bene cial to send a discontinuation letter to the patients' GP and family in addition to deprescribing hypnotics drugs during hospital stay [41]. In fact, the individual healthcare professional could be the most important contributing factor to hypnotic discontinuation underlining the importance of involving the patients' GP early on in the deprescribing process [33]. As the patient's family had a considerable in uence on the decision to participate in this study, their importance should not be overestimated.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Determinants of Hypnotic Discontinuation One Month After Discharge from an Acute Geriatric Ward: A Prospective, Observational Study

Brantegem

Liesenborghs

Hias

et al. 2020

Preprint

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BackgroundDeprescribing long-term hypnotic drug use is recommended in older adults to reduce medication-related harm such as falls. It is currently unknown whether this might be feasible in geriatric inpatients. The aim of this study was hence to determine predisposing factors for discontinuation of benzodiazepines and Z-drugs one month after discharge in geriatric inpatients receiving usual care.MethodsA prospective observational study was performed at the University Hospitals Leuven (UZ Leuven, Belgium). Patient characteristics, hypnotic drug use and sleep quality were gathered up to one month after discharge. A multivariable logistic regression model was used to identify independent determinants.ResultsChronic hypnotic drug use was highly prevalent (26.6%) in the geriatric population of UZ Leuven. Ninety-six patients with a mean age of 85.7 (SD 4.7) years admitted to the acute geriatric ward over a period of 10 months were included for analysis. Upon admission, 74% used a benzodiazepine and 26% a Z-drug. One month after discharge, 35 patients (36.5%) discontinued the hypnotic drug and in 23 cases (24.0%) the equivalent daily dose was reduced. Cessation of the hypnotic drug during hospitalization was found to be the only determinant influencing discontinuation one month after discharge with an odds ratio of 9.43 (95% confidence interval: 3.23 – 32.13). This was not associated with any deterioration of sleep quality.ConclusionsThis study confirms the overuse of long-term BZD and Z-drug use in geriatric patients. Cessation of hypnotic drugs during hospitalization was strongly associated with persistent discontinuation one month after discharge.Trial registrationThe study was approved by the Ethics Committee of UZ Leuven (registration number B322201629331).

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Section: Discussioncontrasting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Determinants of Hypnotic Discontinuation One Month After Discharge from an Acute Geriatric Ward: A Prospective, Observational Study

Brantegem

Liesenborghs

Hias

et al. 2020

Preprint

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“…Thus, a maximum duration of between 2 and 4 weeks for insomnia or anxiety and no more than 2 weeks for mixed anxiety-depressive disorders are advised [11]. These recommendations were based on the longterm development of tolerance, dependence, abuse and withdrawal syndrome [12], although recent retrospective studies showed a level of dependence after chronic consumption that was lower than previously described, even in older people [13]. In any case, BZDs have been demonstrated to increase the risk of falls, hip fractures and detrimental cognitive effects [14,15].…”

Section: Introductionmentioning

confidence: 99%

Trends in the consumption rates of benzodiazepines and benzodiazepine-related drugs in the health region of Lleida from 2002 to 2015

et al. 2020

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Background The high prevalence and long-term use of benzodiazepines (BZDs) treatment are debated topics because of the risk they can cause to the patients. Despite the current information on the risk-benefit balance of these drugs, their consumption remains particularly high. We determined the trend in the consumption prevalence of benzodiazepines (BZDs) and drugs related to BZDs (Z-drugs) in the population of the Health Region of Lleida to explore patterns of use and the associated characteristics associated between 2002 and 2015. Methods An analysis of secular trends was carried out between 2002 and 2015; the databased included all individuals from the Health Region of Lleida, which had 358,157 inhabitants in 2015, that consumed BZDs. The consumption of BZDs was evaluated using prescription billing data from the Public Health System. All types of BZDs and BZD analogues that had been approved by the drug agency were included. Trends by age and sex were investigated. Results Over the whole study period, a total of 161,125 individuals accounted for 338,148 dispensations. Overall, 59% were women, and the mean age was 56 years. The dispensing prevalence of BZDs use in 2015 was 14.2% overall —18.8% in women and 9.6% in men—and was 36% in those over 65 years. According to the half-life of BZDs, the prevalence of short-intermediate BZD use, intermediate-long BZD use, and Z-drugs use was 9.7, 5.5 and 0.8%, respectively. The evolution of the annual prevalence of BZD dispensing showed a progressive decline, from 15.3% in 2002 to 14.2% in 2015, which was attributed to a decrease in the consumption of intermediate-long half-life BZDs (8.0% vs. 5.5%) and Z-drugs (1.4% vs. 0.8%). Conclusion The dispensing prevalence of BZDs and Z-drugs was high, although a small reduction was observed during this time period. The dispensing prevalence was especially high in the population over 65, despite the risk of cognitive decline and falls. Integral actions are required to lower the BZD prescription rate.

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“…16 Long-term use of multiple sedative-hypnotics is rarely warranted and is especially dangerous in the elderly. 17,18 Advanced age was found to be associated with longterm treatment with BZDRs in this study. A previous study found that in the geriatric population, use of BZDRs increased with age.…”

Section: Discussionmentioning

confidence: 55%

“…[13][14][15][16] As a result, several authors have suggested possible means to discourage and reduce use of BZDRs in elderly patients. 17,18 In previous research investigating the relationship between BZDRs and dementia, the study population mostly consisted of community-dwelling individuals. 19 Our study utilised a hospital-based population from a psychiatric centre in Taiwan.…”

Section: Introductionmentioning

confidence: 99%

The factors associated with inappropriate prescription patterns of benzodiazepines and related drugs among patients with dementia

Tien¹,

Chan

Hsu³

2020

Psychogeriatrics

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Background It has been emphasised that benzodiazepines and related drugs (BZDRs) should be used cautiously in people with dementia. The aim of this study was to identify factors associated with inappropriate prescription patterns of BZDRs including polypharmacy, long‐term treatment and high doses among patients with dementia taking BZDRs. Methods This was a retrospective chart review study of patients with dementia who were treated at the study hospital. The date that the patient was issued a catastrophic illness certificate from the National Health Insurance Administration was used as the index date. Medical records of the 2‐year period after the index date were reviewed. Results A total of 308 patients with dementia were included in this study. Among them, 151 (49.0%) received at least one prescription of BZDRs. After adjusting for covariates, psychiatric comorbidities (adjusted odds ratio (aOR) = 4.74, 95% CI = 1.75–12.81), history of past suicidal behaviour (aOR = 4.25, 95% CI = 1.40–12.88) and long‐term treatment with BZDRs (aOR = 3.38, 95% CI = 1.11–10.27) were associated with polypharmacy of BZDRs. Age (aOR = 1.05, 95% CI = 1.0–1.11) and polypharmacy (aOR = 3.57, 95% CI = 1.23–10.32) were associated with long‐term treatment. Living with family (aOR = 3.33, 95% CI = 1.32–9.79) and fewer psychiatric admissions to the study hospital (aOR = 0.56, 95% CI = 0.36–0.86) were associated with treatment with high doses of BZDRs. Conclusions Treatment with BZDRs is prevalent in patients with dementia. Inappropriate prescription patterns of BZDRs are not uncommon in these patients and may be interlinked.

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Discontinuation of Chronic Benzodiazepine Use Among Adults in the United States

Cited by 13 publications

References 33 publications

Determinants of Hypnotic Discontinuation One Month After Discharge from an Acute Geriatric Ward: A Prospective, Observational Study

Determinants of Hypnotic Discontinuation One Month After Discharge from an Acute Geriatric Ward: A Prospective, Observational Study

Trends in the consumption rates of benzodiazepines and benzodiazepine-related drugs in the health region of Lleida from 2002 to 2015

The factors associated with inappropriate prescription patterns of benzodiazepines and related drugs among patients with dementia

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