Use of benzodiazepines, depressive symptoms and cognitive function in old age

Vliet, Peter Van de; Mast, Roos C. van der; Broek, Martijn van den; Westendorp, Rudi G.J.; Craen, Anton J. M. de

doi:10.1002/gps.2143

Cited by 36 publications

(37 citation statements)

References 34 publications

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“…This chronic concomitant use of psychotropic drugs to treat depression is not appropriate in the geriatric population who has already an increased risk of interactions and adverse drug reactions. On the one hand, it is not surprising we found an association between depression and BZD/Z use, because depression can be the reason of initiating a BZD/Z drug, definitely when depression is related to a disturbed sleep pattern and anxiety [38]. On the other hand, a study in 2007 revealed that the use of hypnotics was associated with an increased incidence of depression, suggesting hypnotics may be contra indicated when there is a risk for depression [39].…”

Section: Insomniamentioning

confidence: 87%

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

Bourgeois

Elseviers

Azermai

et al. 2011

Eur J Clin Pharmacol

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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

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Section: Insomniamentioning

confidence: 87%

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

Bourgeois

Elseviers

Azermai

et al. 2011

Eur J Clin Pharmacol

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“…45 Long-term sedative/anxiolytic drug use has been associated with an increased risk of depression. 46 In turn, depres-…”

Section: Main Findingsmentioning

confidence: 99%

Heavy Drinking and Use of Sedative or Anxiolytic Drugs Among Aging Men: An II-Year Follow-Up of the FinDrink Study

et al. 2011

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The main finding of this study was the association between heavy drinking and subsequent initiation of sedative/anxiolytic drugs that was not fully explained by baseline depressive symptoms. This may inform strategies to optimize the use of sedative/anxiolytic drugs, and assist in the early identification of patients at risk of heavy drinking. Clinicians should consider a patient's alcohol consumption prior to prescribing or dispensing sedative/anxiolytic drugs. Clinicians should also monitor patients prescribed sedative/anxiolytic drugs for subsequent heavy drinking.

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“…3 BDZs have been associated with cognitive impairment, depressive symptoms, poor physical function, falls, and fractures. [4][5][6][7] The responsible prescribing of BDZs in psychiatric disorders has recently been debated. 8 Research into the association between BDZ use and mortality has been inconsistent.…”

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confidence: 99%

Mortality Associated with Benzodiazepines and Benzodiazepine-Related Drugs among Community-Dwelling Older People in Finland: A Population-Based Retrospective Cohort Study

et al. 2011

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Clinical Implications• Adverse drug events associated with BDZs are well documented. However, there are conflicting data about mortality hazards.• In contrast to recent findings from a Canadian study, BDZs and BDZ-related drugs were not associated with excess mortality after adjusting for baseline differences in age, sex, antipsychotic drug use, and diagnoses.• While BDZs and BDZ-related drugs were not associated with excess mortality, clinicians should maintain a judicious approach when prescribing BDZs and BDZ-related drugs for older people. Limitations• The study sample was drawn from a single municipality in Finland and, therefore, may not be generalizable to other populations.• Only large BDZ and BDZ-related drug pack sizes were reimbursed and included in the Finnish National Prescription Register in 2000. This means BDZ and BDZ-related drug use may have been underestimated.• Differences in BDZ and BDZ-related drug dose, frequency, and duration of use were not evaluated. Key Words: hypnotics and sedatives, benzodiazepines, mortality, aged, pharmacoepidemiologyObjective: To investigate the association between the use of benzodiazepines (BDZs) and BDZ-related drugs and mortality among community-dwelling people aged 65 years and older in Finland. Method:This was a population-based retrospective cohort study. Records of all reimbursed drugs purchased by all 2224 residents of Leppävirta, Finland, aged 65 years and older in 2000 were extracted from the Finnish National Prescription Register. Diagnostic data were extracted from the Special Reimbursement Register. All-cause mortality was assessed after 9 years using national registers. Cox proportional hazards models were used to compute unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals for mortality among prevalent users of BDZs and BDZ-related drugs in 2000 (n = 325), compared with nonusers of BDZs and BDZ-related drugs between 2000 and 2008 (n = 1520).Results: BDZs and BDZ-related drugs were used by 325 out of the 2224 residents (14.6%) in 2000. The 9-year mortality was 50.2% among BDZ and BDZ-related drug users in 2000 and 36.3% among BDZ and BDZ-related drug nonusers between 2000 and 2008 (HR 1.53; 95% CI 1.28 to 1.82). After adjusting for baseline age, sex, antipsychotic drug use, and diagnostic confounders, the HR was 1.01 (95% CI 0.84 to 1.21). Conclusions:Use of BDZs and BDZ-related drugs was associated with an increased mortality hazard in unadjusted analyses. However, after adjusting for age, sex, antipsychotic drug use, and diagnostic confounders, the use of BDZs and BDZ-related drugs was not associated with excess mortality.Can J Psychiatry. 2011;56(6):377-381.

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Use of benzodiazepines, depressive symptoms and cognitive function in old age

Cited by 36 publications

References 34 publications

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

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

Heavy Drinking and Use of Sedative or Anxiolytic Drugs Among Aging Men: An II-Year Follow-Up of the FinDrink Study

Mortality Associated with Benzodiazepines and Benzodiazepine-Related Drugs among Community-Dwelling Older People in Finland: A Population-Based Retrospective Cohort Study

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