Benzodiazepine use in Belgian nursing homes: a closer look into indications and dosages

Abstract

AIM:(i)To describe the prevalence of benzodiazepine use in Belgian nursing homes, with specific attention to indications and dosages.(ii)To compare actual and recommended dosages of benzodiazepines for anxiety and insomnia.(iii)To explore the risk profile for chronic benzodiazepine use in institutionalised older adults. METHODS:Medication charts of 1730 residents from 76 nursing homes in Belgium were collected and analysed, using the ATC classification. Drug name, indication and daily dosage were recorded. From authoritative international sources, we extracted for each drug and each indication a daily dosage recommended not to exceed in older adults, for comparison with observed actual dosages. RESULTS:Among the chronic BZD/Z users (50% of the residents), the leading indication was 'insomnia' (59% of the users) followed by 'anxiety' (17%) and 'unrest' (10%). In the chronic prescriptions of BZD/Zs indicated for insomnia, the actual daily dose exceeded the geriatric upper limit: with lormetazepam in 95% ,zolpidem in 82%, zopiclone in 78% and lorazepam in 35% of the prescriptions. In anxiety, daily doses also exceeded the limit but not to the same extend.Multivariate analysis showed BZD/Z use was positively associated with pain (OR 1.58 CI95% 1.27-1.97), constipation ) and depression (OR 1.68 CI95% 1.35-2.08). Residents with dementia were less likely of receiving a BZD/Z (OR 0.60 CI95% 0.48-0.74). CONCLUSION:Efforts to reduce the use of BZD/Zs in nursing homes should concentrate on insomnia, with interventions aimed to reduce too high prevalence of chronic use and too high daily dosages in this indication.3

Prevalence of Neuropsychiatric Symptoms in Young-Onset Compared to Late-Onset Alzheimer’s Disease – Part 1: Findings of the Two-Year Longitudinal NeedYD-Study

“…The lower prevalence of behavioral symptoms in the YO-AD group may be partly explained by the higher frequency of antidementia medication use in this group, although cholinesterase inhibitors only have a modest positive effect on behavioral disturbances [52][53][54]. In addition, more patients in the LO-AD group used benzodiazepines, which may have reduced anxiety and sleeping disturbances in this group [55], but this would mean an even larger difference between groups than currently found. It should be noted that benzodiazepine use has also been associated with a more rapid increase in NPI total [56].…”

“…In the YO-AD group, 78.8% of symptom-free patients (n = 33) at baseline developed a clinically relevant symptom during the 2-year period and in the LO-AD group 100.0% of symptom-free patients (n = 13). 55.9% for anxiety). In both groups, apathy was among the most and euphoria and hallucinations were among the least incident and prevalent symptoms over the 2-year period.…”

Prise de benzodiazépines au long cours chez les patients dialysés : une étude descriptive

“…En effet, ces troubles, plus souvent rencontré s chez les patients atteints de pathologies chroniques, sont en partie lié s à la perception de leur pathologie, de leur qualité de vie ainsi qu'à leur difficulté de s'adapter à leur maladie [38]. Comme constaté en population gé né rale [17,18,21,25], les patients dialysé s consommateurs de BZD de notre é tude les utilisent principalement au long cours (pré valence de 78,3 % à 3 mois et 71,8 % à un an). Ces ré sultats confirment la né cessité de rationaliser l'utilisation de ces molé cules en optimisant le suivi et la duré e de leur prescription, et en apportant une information au patient concernant les risques d'une consommation chronique [33][34][35].…”

“…Wyne et al, dans une revue de la litté rature, rapportent une pré valence de 8 à 26 % d'utilisation des BZD chez les patients dialysé s [19]. Aucune é tude n'é value la consommation au long cours chez les patients dialysé s. Diffé rents facteurs relatifs aux patients (par exemple l'âge, le sexe, l'anté cé dent de dé pression), aux prescripteurs (la spé cialité du prescripteur, par exemple) ou aux BZD elles-mêmes (par exemple le type de BZD, la dose utilisé e) sont identifié s dans la litté rature comme é tant associé s à une utilisation au long cours [18,[20][21][22][23][24][25][26][27][28][29][30][31][32]. L'ensemble de ces facteurs est identifié en population gé né rale.…”

The Use of Antidepressants in Belgian Nursing Homes

“…The PHEBE study was a cross-sectional, descriptive study of a representative stratified random sample of 76 Belgian nursing homes, investigating the overall drug utilisation in Belgian nursing homes in 2006. A detailed description of the methods and findings of this study was published elsewhere [28][29][30] .…”