Benzodiazepine Use and Deprescribing in Belgian Nursing Homes: Results from the<scp>COME‐ON</scp>Study

Evrard, Perrine; Henrard, Séverine; Foulon, Veerle; Spinewine, Anne

doi:10.1111/jgs.16751

Cited by 21 publications

(22 citation statements)

References 42 publications

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“…In a study with 2651 French NHRs receiving an antidepressant, PIP (with regard to indication, drug class, duplication and monitoring) was found in 38.4% of NHRs [ 35 ]. In a Belgian study with 418 NHRs taking a BZRA, 98% of NHRs received the BZRA for more than 4 weeks, and drug–disease and drug–drug interactions were found in two-thirds of users overall [ 36 ]. In both studies, dementia was associated with less PIP.…”

Section: Methodsmentioning

confidence: 99%

Interventions to optimize medication use in nursing homes: a narrative review

2021

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Purpose Polypharmacy, medication errors and adverse drug events are frequent among nursing home residents. Errors can occur at any step of the medication use process. We aimed to review interventions aiming at optimization of any step of medication use in nursing homes. Methods We narratively reviewed quantitative as well as qualitative studies, observational and experimental studies that described interventions, their effects as well as barriers and enablers to implementation. We prioritized recent studies with relevant findings for the European setting. Results Many interventions led to improvements in medication use. However, because of outcome heterogeneity, comparison between interventions was difficult. Prescribing was the most studied aspect of medication use. At the micro-level, medication review, multidisciplinary work, and more recently, patient-centered care components dominated. At the macro-level, guidelines and legislation, mainly for specific medication classes (e.g., antipsychotics) were employed. Utilization of technology also helped improve medication administration. Several barriers and enablers were reported, at individual, organizational, and system levels. Conclusion Overall, existing interventions are effective in optimizing medication use. However there is a need for further European well-designed and large-scale evaluations of under-researched intervention components (e.g., health information technology, patient-centered approaches), specific medication classes (e.g., antithrombotic agents), and interventions targeting medication use aspects other than prescribing (e.g., monitoring). Further development and uptake of core outcome sets is required. Finally, qualitative studies on barriers and enablers for intervention implementation would enable theory-driven intervention design.

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Section: Methodsmentioning

confidence: 99%

Interventions to optimize medication use in nursing homes: a narrative review

2021

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“…There is strong evidence that suggests, however, that antipsychotics have modest efficacy and are associated with cerebrovascular events and death [7][8][9]. Despite a relatively high use of benzodiazepines [10][11][12][13], evidence supporting clinical efficacy is very limited [14][15][16] and may be associated with a higher risk of falls, cognitive impairment, and sedation [17,18]. Guidelines advise against a range of antidepressants, especially those with anticholinergic effects, because of side effects and adverse effects [19].…”

Section: Introductionmentioning

confidence: 99%

What Makes Deprescription of Psychotropic Drugs in Nursing Home Residents with Dementia so Challenging? A Qualitative Systematic Review of Barriers and Facilitators

et al. 2021

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Background Behavioral and psychological symptoms of dementia are frequently experienced in the nursing home setting and place a substantial burden on patients, relatives, and nursing home staff. Despite guidelines recommending non-pharmacological treatments, psychotropic drugs are often prescribed to address these symptoms. This is the case despite their effects being limited, and there being a risk of side effects and adverse events for the patient. Several studies have aimed to reduce the use of psychotropic drugs, with varying results. The reasons behind these variations are not well understood. Objectives The objective of this systematic review was to investigate which factors nursing home general practitioners and nursing home staff experience as barriers or facilitators when attempting to deprescribe psychotropic drugs in nursing home residents. Methods We searched PubMed, EMBASE, psycINFO, Web of Science, and CINAHL between April and September 2020. An inductive method using thematic analysis of the qualitative findings was applied for the derivation of themes. Quantitative studies were included but described descriptively and separately. Results Of 8204 unique records, 14 studies were included in the review. Of these, nine were interview or focus group studies and five were survey studies. Thematic analysis resulted in five major themes identified as either facilitators or barriers or both: (1) 'Operationality and routines'; (2) 'Lack of resources and qualifications'; (3) 'Patient-related outcomes', which points to a strong belief in negative patient-related outcomes of discontinuation and a downplay of side effects of the medication; (4) 'Policies', including support and buy-in from nursing home leadership; and (5) 'Collaboration' between physicians and nursing home staff. Themes 1 and 4 consist of facilitators. Theme 2 consists of barriers. Theme 3 and 5 consist of both facilitators and barriers. Evaluation of closed-ended questions from the surveys supported the findings. Conclusions Deprescribing psychotropic drugs used for behavioral and psychological symptoms of dementia in nursing home residents is challenging. Resources need to be in place for deprescribing, as well as there being a focus on the positive patient-related outcomes of doing so. Managerial support, staff routines, and interprofessional collaboration are some factors facilitating the process, in addition to there being routines and systematic procedures in place allowing for operationality and a common understanding. Addressing these barriers and facilitators is necessary to ensure that deprescribing can be understood as meaningful and pursued among healthcare professionals in the nursing home setting.

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“… 18 – 20 In the Belgian nursing home setting, a recent study by Evrard et al showed that a history of fall in the past 3 months, chronic obstructive pulmonary disease, polypharmacy, insomnia, and antidepressant use were factors associated with BZRA use. 17 On the contrary, dementia and trazodone use were factors negatively associated with BZRA use. 17 However, no study has been conducted to identify factors associated with BZRA use in older people from the general Belgian older population.…”

Section: Introductionmentioning

confidence: 98%

“… 17 On the contrary, dementia and trazodone use were factors negatively associated with BZRA use. 17 However, no study has been conducted to identify factors associated with BZRA use in older people from the general Belgian older population.…”

Section: Introductionmentioning

confidence: 98%

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Trends in benzodiazepine receptor agonists use and associated factors in the Belgian general older population: analysis of the Belgian health interview survey data

Pétein

Spinewine

Henrard

2021

Therapeutic Advances in Psychopharmacology

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Background: Benzodiazepine receptor agonists (BZRA), which include benzodiazepines and z-drugs, are commonly prescribed for insomnia and anxiety in older adults, and used often long term. Yet, the risk–benefit ratio of BZRA use in older adults may be unfavorable and many recommendations suggest avoidance or a maximal treatment duration of 4 weeks. The aim of this study was to describe trends of BZRA use in older adults and associated factors. Methods: Using data from the Belgian Health Interview Survey in 2004 ( n = 3594), 2008 ( n = 2917), and 2013 ( n = 2048), prevalence standardized for age, sex, and region were calculated to assess trends of BZRA use in people ⩾65 years. Analysis of associated factors to BZRA use was performed using a sub-sample of 2013 data for which variables assessing sleeping disorder and anxiety disorder were not missing ( n = 1286). Variables from seven main topics were explored using multivariate logistic regression: socio-demographic factors, geriatric factors, comorbidities, subjective health and mental health indicators, social health indicators, medication use and healthcare services use. Results: Overall, standardized prevalence of BZRA use decreased significantly between 2004 and 2013 [22% to 18%, prevalence difference (95% confidence interval, CI): −4.0% (−6.8; −1.3)]. Factors associated with BZRA use in multivariable analysis included female gender [adjusted odds ratio (aOR) (95%CI) : 1.62 (1.14; 2.29)], poor mental health [aOR (95%CI): 1.73 (1.13–2.63)] a fall in the past 12 months [aOR (95%CI): 1.52 (1.02; 2.26), reporting a sleeping disorder [aOR (95%CI): 1.92 (1.35; 2.72)], polypharmacy [aOR (95%CI): 2.51 (1.75; 3.60)], and trazodone use [aOR (95%CI): 4.05 (1.64; 10.21)]. Conclusion: Despite an encouraging decline observed from 2004 to 2013, BZRA use remained highly prevalent in Belgian older adults. Promotion of alternatives to BZRA in treatment of sleeping problems need to be continued. Among BZRA older users, women, the oldest (⩾85 years) and high-risk subgroups should be targeted in deprescribing interventions.

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Benzodiazepine Use and Deprescribing in Belgian Nursing Homes: Results from theCOME‐ONStudy

Cited by 21 publications

References 42 publications

Interventions to optimize medication use in nursing homes: a narrative review

Interventions to optimize medication use in nursing homes: a narrative review

What Makes Deprescription of Psychotropic Drugs in Nursing Home Residents with Dementia so Challenging? A Qualitative Systematic Review of Barriers and Facilitators

Trends in benzodiazepine receptor agonists use and associated factors in the Belgian general older population: analysis of the Belgian health interview survey data

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