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

Jolyce Bourgeois UGent, Monique Elseviers UGent, Majda Azermai UGent, Lucas Van Bortel UGent, Mirko Petrovic UGent and Robert Vander Stichele UGent (2012) EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY. 68(5). p.833-844
abstract
(1) To describe the prevalence of benzodiazepine use in Belgian nursing homes, with specific attention to indications and dosages. (2) To compare actual and recommended dosages of benzodiazepines for anxiety and insomnia. (3) To explore the risk profile for chronic benzodiazepine use in institutionalised older adults. Medication charts of 1,730 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 be exceeded in older adults for comparison with observed actual dosages. Among the chronic benzodiazepine or z-drug (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 in 95% of lormetazepam prescriptions, 82% of zolpidem, 78% of zopiclone and 35% of lorazepam prescriptions. For anxiety, daily doses also exceeded the limit but not to the same extent. Multivariate analysis showed BZD/Z use was positively associated with pain (OR 1.58, 95% CI 1.27-1.97), constipation (OR 1.43, 95% CI 1.16-1.76) and depression (OR 1.68, 95% CI 1.35-2.08). Residents with dementia were less likely to receive a BZD/Z (OR 0.60, 95% CI 0.48-0.74). Efforts to reduce the use of BZD/Zs in nursing homes should concentrate on insomnia, with interventions aimed at reducing too high prevalence of chronic use and too high daily dosages in this indication.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
DEMENTIA, INTERVENTIONS, Benzodiazepines, Aged, Drug utilisation, Pharmacoepidemiology, LONG-TERM USE, MEDICATION USE, PSYCHOTROPIC-DRUGS, CHRONIC INSOMNIA, CONSENSUS PANEL, OLDER-ADULTS, RESIDENTS, RISK
journal title
EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY
Eur. J. Clin. Pharmacol.
volume
68
issue
5
pages
833 - 844
Web of Science type
Article
Web of Science id
000303452800040
JCR category
PHARMACOLOGY & PHARMACY
JCR impact factor
2.741 (2012)
JCR rank
93/259 (2012)
JCR quartile
2 (2012)
ISSN
0031-6970
DOI
10.1007/s00228-011-1188-z
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
1954521
handle
http://hdl.handle.net/1854/LU-1954521
date created
2011-11-25 20:35:00
date last changed
2012-09-20 11:52:05
@article{1954521,
  abstract     = {(1) To describe the prevalence of benzodiazepine use in Belgian nursing homes, with specific attention to indications and dosages. (2) To compare actual and recommended dosages of benzodiazepines for anxiety and insomnia. (3) To explore the risk profile for chronic benzodiazepine use in institutionalised older adults. 
Medication charts of 1,730 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 be exceeded in older adults for comparison with observed actual dosages. 
Among the chronic benzodiazepine or z-drug (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 in 95\% of lormetazepam prescriptions, 82\% of zolpidem, 78\% of zopiclone and 35\% of lorazepam prescriptions. For anxiety, daily doses also exceeded the limit but not to the same extent. Multivariate analysis showed BZD/Z use was positively associated with pain (OR 1.58, 95\% CI 1.27-1.97), constipation (OR 1.43, 95\% CI 1.16-1.76) and depression (OR 1.68, 95\% CI 1.35-2.08). Residents with dementia were less likely to receive a BZD/Z (OR 0.60, 95\% CI 0.48-0.74). 
Efforts to reduce the use of BZD/Zs in nursing homes should concentrate on insomnia, with interventions aimed at reducing too high prevalence of chronic use and too high daily dosages in this indication.},
  author       = {Bourgeois, Jolyce and Elseviers, Monique and Azermai, Majda and Van Bortel, Lucas and Petrovic, Mirko and Vander Stichele, Robert},
  issn         = {0031-6970},
  journal      = {EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY},
  keyword      = {DEMENTIA,INTERVENTIONS,Benzodiazepines,Aged,Drug utilisation,Pharmacoepidemiology,LONG-TERM USE,MEDICATION USE,PSYCHOTROPIC-DRUGS,CHRONIC INSOMNIA,CONSENSUS PANEL,OLDER-ADULTS,RESIDENTS,RISK},
  language     = {eng},
  number       = {5},
  pages        = {833--844},
  title        = {Benzodiazepine use in Belgian nursing homes: a closer look into indications and dosages},
  url          = {http://dx.doi.org/10.1007/s00228-011-1188-z},
  volume       = {68},
  year         = {2012},
}

Chicago
Bourgeois, Jolyce, Monique Elseviers, Majda Azermai, Lucas Van Bortel, Mirko Petrovic, and Robert Vander Stichele. 2012. “Benzodiazepine Use in Belgian Nursing Homes: a Closer Look into Indications and Dosages.” European Journal of Clinical Pharmacology 68 (5): 833–844.
APA
Bourgeois, Jolyce, Elseviers, M., Azermai, M., Van Bortel, L., Petrovic, M., & Vander Stichele, R. (2012). Benzodiazepine use in Belgian nursing homes: a closer look into indications and dosages. EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY, 68(5), 833–844.
Vancouver
1.
Bourgeois J, Elseviers M, Azermai M, Van Bortel L, Petrovic M, Vander Stichele R. Benzodiazepine use in Belgian nursing homes: a closer look into indications and dosages. EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY. 2012;68(5):833–44.
MLA
Bourgeois, Jolyce, Monique Elseviers, Majda Azermai, et al. “Benzodiazepine Use in Belgian Nursing Homes: a Closer Look into Indications and Dosages.” EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY 68.5 (2012): 833–844. Print.