The incidence rate of depression in the elderly population is low except when episodes of clinically relevant depressive symptoms are accounted for. Most late-life depression occurs in persons with a history of depression. Moreover, the recurrence rate of depressive syndromes does not differ between men and women.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • The risk of adverse events due to chronic benzodiazepine use is high in the elderly. • Cross‐sectional studies have shown that increasing age, female gender and poor physical and mental health are associated with benzodiazepine use. • When users were re‐examined some years later, chronic somatic disease, pain and stress seemed to contribute to the continuation of benzodiazepine use. WHAT THIS STUDY ADDS • This is the first longitudinal study that analyzed the determinants of new‐onset chronic benzodiazepine use in community‐dwelling elderly. • Symptoms of depression, hypertension, pain related joint complaints and the perception of poor physical health predicted new‐onset chronic use. Living alone was found to decrease the risk of chronic use. AIMS The risk of adverse events due to chronic benzodiazepine use is high in the elderly. Clinicians need to be able to identify those persons who are at risk of chronic benzodiazepine use, but little is known about the determinants. This study determined social and health related factors that predict new‐onset chronic benzodiazepine use in community‐dwelling elderly. METHODS This study was embedded in an ongoing cohort study among 5364 persons aged ≥57 years. Drug‐dispensing medication records were available for the period between 1991 and 2003. We defined chronic benzodiazepine use as use during at least 180 days in a period of 365 consecutive days. The association of various social, psychiatric and somatic variables with new‐onset chronic benzodiazepine use was studied with a Cox proportional hazards analysis. RESULTS Symptoms of depression, hypertension, pain related joint complaints and the perception of poor physical health predicted new‐onset chronic use. In the subsample of participants who had filled at least one prescription in the follow‐up period, of these variables only pain related joint complaints increased the risk of new‐onset chronic use. Living alone protected against chronic benzodiazepine use. CONCLUSIONS The elderly with poor mental and physical health are at an increased risk of chronic benzodiazepine use. Living alone was found to decrease the risk of chronic use, which suggests that social factors may determine drug usage patterns. Very few characteristics predicted chronic benzodiazepine use once patients had received their first prescription. For clinicians, identification of patients at high risk is therefore not straightforward.

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