Advanced search
2 files | 1.51 MB

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

Author
Organization
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.
Keywords
DEMENTIA, INTERVENTIONS, Benzodiazepines, Aged, Drug utilisation, Pharmacoepidemiology, LONG-TERM USE, MEDICATION USE, PSYCHOTROPIC-DRUGS, CHRONIC INSOMNIA, CONSENSUS PANEL, OLDER-ADULTS, RESIDENTS, RISK

Downloads

  • (...).pdf
    • full text
    • |
    • UGent only
    • |
    • PDF
    • |
    • 933.29 KB
  • BOURGEOIS et al EJCP2011Final.pdf
    • full text
    • |
    • open access
    • |
    • PDF
    • |
    • 576.47 KB

Citation

Please use this url to cite or link to this publication:

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.
@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},
}

Altmetric
View in Altmetric
Web of Science
Times cited: