Prevalence, country-specific prescribing patterns and determinants of benzodiazepine use in community-residing older adults in 7 European countries

Abstract

Background The use of benzodiazepines (BZDs) in older population is often accompanied by drug-related complications. Inappropriate BZD use significantly alters older adults’ clinical and functional status. This study compares the prevalence, prescribing patterns and factors associated with BZD use in community-dwelling older patients in 7 European countries. Methods International, cross-sectional study was conducted in community-dwelling older adults (65 +) in the Czech Republic, Serbia, Estonia, Bulgaria, Croatia, Turkey, and Spain between Feb2019 and Mar2020. Structured and standardized questionnaire based on interRAI assessment scales was applied. Logistic regression was used to evaluate factors associated with BZD use. Results Out of 2,865 older patients (mean age 73.2 years ± 6.8, 61.2% women) 14.9% were BZD users. The highest prevalence of BZD use was identified in Croatia (35.5%), Spain (33.5%) and Serbia (31.3%). The most frequently prescribed BZDs were diazepam (27.9% of 426 BZD users), alprazolam (23.7%), bromazepam (22.8%) and lorazepam (16.7%). Independent factors associated with BZD use were female gender (OR 1.58, 95%CI 1.19–2.10), hyperpolypharmacy (OR 1.97, 95%CI 1.22–3.16), anxiety (OR 4.26, 95%CI 2.86–6.38), sleeping problems (OR 4.47, 95%CI 3.38–5.92), depression (OR 1.95, 95%CI 1.29–2.95), repetitive anxious complaints (OR 1.77, 95%CI 1.29–2.42), problems with syncope (OR 1.78, 95%CI 1.03–3.06), and loss of appetite (OR 0.60, 95%CI 0.38–0.94). In comparison to Croatia, residing in other countries was associated with lower odds of BZD use (ORs varied from 0.49 (95%CI 0.32–0.75) in Spain to 0.01 (95%CI 0.00–0.03) in Turkey), excluding Serbia (OR 1.11, 95%CI 0.79–1.56). Conclusions Despite well-known negative effects, BZDs are still frequently prescribed in older outpatient population in European countries. Principles of safer geriatric prescribing and effective deprescribing strategies should be individually applied in older BZD users.

Polypharmacy and potentially inappropriate prescribing of benzodiazepines in older nursing home residents

“…According to the Annual Report on Drug Use in Croatia in 2022, diazepam and alprazolam were among the top 10 medications most often used in this country [ 46 ]. The EuroAgeism project reported similar patterns to those that we observed among NH older persons, with diazepam being the most prescribed benzodiazepine in Croatia also among community-dwelling older adults [ 43 ]. A national study using claims data confirmed that benzodiazepine prescriptions increased by 4.1% in Croatia between 2015 and 2016 [ 39 ]; therefore, strategies to improve the appropriateness of benzodiazepine prescribing in Croatia appear to be needed.…”

“…Another contributing factor that could explain the high prevalence of potentially inappropriate benzodiazepine prescribing and regional variations is the absence of national guidelines on rational benzodiazepine prescribing in geriatric patients in Croatia [ 39 ]. In the EuroAgeism H2020 project (2017–2022) conducted in older patients visiting pharmacies in eight European countries, the exposure to benzodiazepines in Croatia was the highest (35.5%) across all included countries (with the lowest prevalence in Turkey, 0.7%) [ 43 ]. The EuroAgeism project [ 44 ] aimed to identify the most common prescribing problems in older adults in Central and South-Eastern Europe (in the Czech Republic, Estonia, Serbia, Croatia, Bulgaria, Turkey and Spain) to support the need for availability of clinical pharmacy services.…”