What is the point of guidelines? Benzodiazepine and z-hypnotic use by an elderly population

Neutel, C. Ineke; Skurtveit, Svetlana; Berg, Christian

doi:10.1016/j.sleep.2011.12.014

Cited by 53 publications

(58 citation statements)

References 40 publications

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“…Bourgeois et al and de Souto Barreto et al identified a higher benzodiazepine use (50 % or 53.4 %) among the institutionalized Belgian and French elderly, correlated with the presence of pain syndromes and polypharmacy, but the administration of long half-life molecules or of unadjusted dosages represented potential DRP common to our subgroup [39, 40]. Among the ambulatory 70–89 years old Norwegian population, Neutel et al found a higher benzodiazepine use that the one identified in our subgroup, with a 12.3 % prevalence of inappropriate use of benzodiazepines as hypnotics or anxiolytics [41]. Almost 20 % of the institutionalized elderly received antipsychotics, with haloperidol as the most frequently prescribed, while their use was infrequent in the ambulatory sample.…”

Section: Discussionmentioning

confidence: 79%

Potentially inappropriate medications in elderly ambulatory and institutionalized patients: an observational study

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2016

BMC Pharmacol Toxicol

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BackgroundThe elderly are frequently exposed to drug related problems causing hospitalizations and increased costs of care. Information about Romanian prescribing practices among the elderly and potential medication associated- risks is lacking. The objective of this study was to identify and compare the most frequent potentially inappropriate medications (PIM) recommended to ambulatory and institutionalized Romanian elderly, through an observational retrospective design.MethodsAll reimbursed medications prescribed to a sample of ambulatory elderly accessing two community pharmacies and all medications recommended to a group of institutionalized elderly (urban facilities, Romania, same month) were analyzed. The STOPP/START criteria and the PRISCUS list were used for PIM identification and for classification as misprescribed, underprescribed or overprescribed -subtypes.ResultsThe analysis involved 345 prescriptions recommended to ambulatory elderly and 91 medical files available for the institutionalized patients. The ambulatory elderly had a mean age of 74.8 years old and were daily exposed to a median number of 3 prescribed medications. The institutionalized elderly were older (mean age 80.77) received 8 medications daily and 69 % of them were functionally dependent. Cardiovascular and neuropsychiatric indications were the most frequent: 64.34 % and 18.55 % of the ambulatory prescriptions, 93.40 % and 41.75 % of the institutionalized patients’ medical files. 159 PIM were identified on 34.49 % of the ambulatory prescriptions. 82.41 % of the institutionalized patients’ medical files contained 140 PIM. The potential underprescribing of cardiovascular therapies was the most frequent PIM category on the ambulatory prescriptions (55.34 % of all PIM), while for the institutionalized patients’ medical files, the misprescribed and overprescribed PIM were those predominantly represented (62.14 % and 27.14 % of all PIM). In both subgroups of data, NSAIDs (56.66 % of ambulatory prescriptions and 35.63 % of institutionalized patients’ data) and benzodiazepines (26.66 % of ambulatory prescriptions and 24.13 % of institutionalized patient’s data) were predominantly misprescribed. Anticholinergics were rarely used (0.62 % of total PIM from ambulatory prescriptions, 2.14 % of total PIM from institutionalized patients’ data).ConclusionsThe PIM identified in both elderly groups suggested potential risks for the occurrence of adverse events specific to the elderly population. Larger studies, both observational and interventional, are needed to ensure a safer therapeutic approach.

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Section: Discussionmentioning

confidence: 79%

Potentially inappropriate medications in elderly ambulatory and institutionalized patients: an observational study

Primejdie

Bojiţă

Popa

2016

BMC Pharmacol Toxicol

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“…27 Other international studies have shown an increase in Z-drug use over time while benzodiazepine use decreased, especially among people over 65 years of age. [28][29][30][31] In Canada, prescribing of benzodiazepines and Z-drugs in British Columbia decreased slightly from 1996 to 2006 in older people, but increased in younger segments of the population (females and people with low income). 20 To set our results in the context of other reports and to assess use of these drugs in the oldest and youngest groups, we stratified our population into 3 age groups.…”

Section: Discussionmentioning

confidence: 99%

Use of benzodiazepines and related drugs in Manitoba: a population-based study

et al. 2014

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Background: Despite their favourable toxicology profile, benzodiazepines and the related Z-drugs (zopiclone, zolpidem and zaleplon) have been associated with physiological tolerance, dependence and addiction. Evidence of harm (e.g., falls, motor vehicle collisions and cognitive disturbances) has been reported in older populations. The aim of this study was to determine the relation between users' characteristics and the use of benzodiazepines and Z-drugs in Manitoba over a 16-year period. Methods:This time-series analysis was based on prescription data from Apr. 1, 1996, to Mar. 31, 2012, obtained from the Drug Product Information Network database of Manitoba. We obtained sociodemographic information on benzodiazepine and Z-drug users from the Population Registry and determined changes in utilization rates over time using generalized estimating equations.Results: Overall, the prevalence of benzodiazepine use remained stable at about 61.0 per 1000 population between 1996/97 and 2011/12; however, the prevalence of Z-drug use increased steadily from 10.9 to 37.0 per 1000 over the same period. In older people (≥ 65 yr), the incidence of benzodiazepine use decreased from 55.5 to 30.3 users per 1000, whereas the incidence of Z-drug use increased from 7.3 to 20.3 users per 1000 over the study period. Among those 18-64 years of age, the incidence of benzodiazepine use decreased from 30.1 to 27.6 users per 1000, but the increase in incidence of Z-drug use was more than 2-fold. The youngest population (≤ 17 yr) showed the lowest rates of use of these drugs. The highest rates of use were observed among older women and the low-income population.Interpretation: Over the study period, benzodiazepines have been prescribed less frequently to older patients in Manitoba; however, zopiclone prescribing has continued to increase for all age groups. The reasons for this increase remain to be determined. AbstractCMAJ OPEN, 2(4) E209 Research CMAJ OPEN Methods Study populationAll Manitoba residents registered with the provincial health care system who were prescribed a benzodiazepine or a Z-drug between 1996/97 and 2011/12 were included. No age restrictions were applied, but patients were stratified by sex and age (0-17, 18-64 and ≥ 65 yr). Location of residence (urban v. rural) and socioeconomic status were also assessed. According to validated definitions, 23 incident (new) users were defined as people who had not received a prescription for any of the medications of interest in the year before receiving their first prescription, while prevalent users for each fiscal year were defined as people who had received at least 1 pres cription for a medication of interest that year.

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“…Both drugs are recognized as having a lower abuse potential compared to the benzodiazepines (UN, 2004(UN, and, 2014WHO 2006). Notably, the high prescription rate of these hypnotics has been identified as an important clinical and public health problem (Bertisch et al, 2014;Moloney et al, 2011;Neutel et al, 2012). High availability and convenience may be major reasons among prescription drug abusers for using medicines rather than illicit drugs (Inciardi et al, 2009).…”

Section: Main Findings and Their Interpretationmentioning

confidence: 99%

Non-prescribed use of psychoactive prescription drugs among drug-impaired drivers in Sweden

Tjäderborn

Jönsson

Sandström

et al. 2016

Drug and Alcohol Dependence

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Aims: To determine the prevalence of non-prescribed drug use among subjects suspected of drug-impaired driving with a confirmed intake of a psychoactive prescription drug, and to identify associated factors. Methods:Subjects investigated for drug-impaired driving in Sweden during 2006-2009 with a confirmed intake of diazepam, flunitrazepam, tramadol, zolpidem or zopiclone were identified using the Swedish Forensic Toxicology Database. Information on dispensed prescription drugs was retrieved from the Swedish Prescribed Drug Register. Non-prescribed use was defined as a confirmed use of a psychoactive prescription drug intake confirmed by toxicological analysis in a subject by whom it was not dispensed in the 12 months preceding the sampling. Prevalence proportions were calculated for each drug and logistic regression was used to identify associated factors. Results: In total, 2225 subjects were included. The median age (range) was 34 (15-80) years and 1864 (83.8%) subjects were male. Non-prescribed use was found in 1513 subjects (58.7%); for flunitrazepam 103 (76.3%), diazepam 1098 (74.1%), tramadol 192 (40.3%), zopiclone 60 (29.7%), and zolpidem 60 (21.2%) subjects, respectively. Younger age and multiple-substance use were associated with nonprescribed use, whereas ongoing treatment with other psychoactive drugs was negatively associated with nonprescribed use. Conclusions: Non-prescribed use of psychoactive prescription drugs was common in subjects suspected of drug-impaired driving and was more frequent for benzodiazepines and tramadol compared to zolpidem and zopiclone. The young and multi-substance users were more likely, whereas subjects with ongoing prescribed treatment with other psychoactive drugs were less likely, to use non-prescribed drugs.

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What is the point of guidelines? Benzodiazepine and z-hypnotic use by an elderly population

Cited by 53 publications

References 40 publications

Potentially inappropriate medications in elderly ambulatory and institutionalized patients: an observational study

Potentially inappropriate medications in elderly ambulatory and institutionalized patients: an observational study

Use of benzodiazepines and related drugs in Manitoba: a population-based study

Non-prescribed use of psychoactive prescription drugs among drug-impaired drivers in Sweden

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