Long-term use of benzodiazepines and related drugs among community-dwelling individuals with and without Alzheimer’s disease

Abstract

The aim of this study was to investigate the prevalence of benzodiazepine and related drug (BZDR) use, especially long-term use, and associated factors among community-dwelling individuals with and without Alzheimer's disease (AD). We utilized data from the MEDALZ-2005 cohort, which includes all community-dwelling individuals diagnosed with AD in Finland at the end of 2005 and matched comparison individuals without AD. Register-based data included prescription drug purchases, comorbidities, and hospital discharge diagnoses. In this study, 24,966 individuals with AD and 24,985 individuals without AD were included. During the 4-year follow-up, we found that 45% (N = 11,312) of individuals with AD and 38% (N = 9534) of individuals without AD used BZDRs. The prevalence of long-term (≥ 180 days) BZDR use was more common among individuals with AD (30%) than individuals without AD (26%). The median durations of the first long-term use periods of BZDRs were 1.5 and 2 years for individuals with and without AD, respectively. Factors associated with long-term BZDR use included female sex, AD, schizophrenia, bipolar disorder, depression, coronary artery disease, and asthma/chronic obstructive pulmonary disease. The high prevalence of long-term BZDR use among individuals with AD is especially a cause for concern because long-term use may further impair cognition and may be associated with serious adverse events.

A Comparison of Sex Differences in Psychotropic Medication Use in Older People with Alzheimer’s Disease in the US and Finland

“…Medication exposure in the MEDALZ data was defined as medications used during a 2-week period before the index date from register-based data. The use periods were modeled with the PRE2DUP method as previously described [31–33]. Exposure to psychotropic medication was defined as the use of an antidepressant, antipsychotic, or an anxiolytic, sedative, or hypnotic.…”

Concomitant use of benzodiazepines and opioids in community‐dwelling older people with or without Alzheimer's disease—A nationwide register‐based study in Finland

“…[1][2][3] The use of BZDRs in older people is problematic because they are associated with several risks, such as sedation, dependence, falls, and fractures. [1][2][3] The use of BZDRs in older people is problematic because they are associated with several risks, such as sedation, dependence, falls, and fractures.…”

“…6,7 The American Geriatrics Society (AGS) Beers Criteria include a strong recommendation to avoid the use of BZDRs in older patients. 3,[9][10][11] In fact, it has been estimated that 30% of community-dwelling older patients with AD and 26% of those without AD are long-term users of BZDRs. 3,[9][10][11] In fact, it has been estimated that 30% of community-dwelling older patients with AD and 26% of those without AD are long-term users of BZDRs.…”

Risk of pneumonia associated with incident benzodiazepine use among community-dwelling adults with Alzheimer disease

“…Benzodiazepines and Z-drugs are frequently prescribed for this population, and long-term use is typical. 8,30 Pneumonia often leads to admission to hospital, 10 and patients with dementia are at increased risk of death related to pneumonia. 12,13 Although our findings need further research and confirmation, the increased risk of pneumonia should be considered when benzodiazepines and Z-drugs are prescribed to older adults with Alzheimer disease.…”

“…8,22 We based our model on sliding averages of daily dose, and we modelled each Anatomic Therapeutic Chemical classification system code separately for each participant according to purchase regularity, taking into account admissions to hospital, stockpiling of drugs and changing dose as described previously. 8,22 We defined use of benzodiazepines and Z-drugs by the following Anatomic Therapeutic Chemical classification system codes: N05BA and N05CD for benzodiazepines and N05CF for Z-drugs. Benzodiazepines prescribed in this study included diazepam, nitrazepam, chlordiazepoxide, clobazam, oxazepam, alprazolam, lorazepam and temazepam, whereas Z-drugs included zopiclone and zolpidem.…”