Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-10T15:08:14.974Z Has data issue: false hasContentIssue false
  • English
  • Français

Correlates of Potentially Inappropriate Prescriptions of Benzodiazepines among Older Adults: Results from the ESA Study*

Published online by Cambridge University Press:  17 July 2012

Michel Préville ,
Cindy Bossé ,
Helen-Maria Vasiliadis ,
Philippe Voyer ,
Claudine Laurier ,
Djamal Berbiche ,
Guiilhème Pérodeau ,
Sébastien Grenier ,
Sarah-Gabrielle Béland  and
Pierre-Alexandre Dionne
...Show all authors
Michel Préville*
Affiliation:
Université de Sherbrooke Charles LeMoyne Hospital Research Center
Cindy Bossé
Affiliation:
Université de Sherbrooke
Helen-Maria Vasiliadis
Affiliation:
Université de Sherbrooke Charles LeMoyne Hospital Research Center
Philippe Voyer
Affiliation:
Université Laval
Claudine Laurier
Affiliation:
Université de Montréal
Djamal Berbiche
Affiliation:
Charles LeMoyne Hospital Research Center
Guiilhème Pérodeau
Affiliation:
Charles LeMoyne Hospital Research Center Université du Québec en Outaouais
Sébastien Grenier
Affiliation:
Charles LeMoyne Hospital Research Center
Sarah-Gabrielle Béland
Affiliation:
Université de Montréal
Pierre-Alexandre Dionne
Affiliation:
Université de Sherbrooke
Lia Gentil
Affiliation:
Université de Sherbrooke
Yola Moride
Affiliation:
Université de Montréal Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM)
*
†Correspondence and requests for offprints should be sent to / La correspondance et les demandes de tirés-à-part doivent être adressées à: Michel Préville, Ph.D. Research Centre, Hôpital Charles LeMoyne 3120, boul. Taschereau Greenfield Park, QC J4V 2H1 michel.preville@usherbrooke.ca)
Get access Rights & Permissions [Opens in a new window]

Abstract

ESA study data were paired with Quebec medical and pharmaceutical services records to document potentially inappropriate benzodiazepines (Bzs) prescriptions among community-dwelling adults aged 65 and older. Results indicate that 32 per cent of respondents took a mean daily dose of 6.1 mg of equivalent diazepam for, on average, 205 days per year. Almost half (48%) of Bzs users received a potentially inappropriate benzodiazepine prescription at least once during the year preceding the survey. About 23 per cent received at least one concomitant prescription of a Bz and another drug that could result in serious interaction. In addition, individuals aged 75 and older were more likely to receive Bzs for a longer period of time than those aged 65–74. Number of pharmacies used was associated with inappropriate Bzs prescriptions. Our results argue in favour of a more integrated health services system, including a regular review of older adults’ drug regimens.

Résumé

Les données de l’étude ESA ont été appariées aux données d’utilisation des services médicaux et pharmaceutiques de la Régie d’assurance maladie du Québec pour documenter la prescription potentiellement non appropriée de benzodiazépines chez les personnes âgées. Nos résultats indiquent que 32% des répondants ont pris une dose journalière moyenne de 6.1 mg de l’équivalent diazépam pour une durée moyenne de 205 jours par année. Nos résultats indiquent aussi que presque la moitié, 48% des utilisateurs de benzodiazépines, ont reçu au moins une prescription de benzodiazépine potentiellement non appropriée pendant les 12 mois qui précédaient l’étude. Près de 23% des consommateurs ont reçu au moins une prescription concomitante de Bzs et d’un autre médicament pouvant résulter en une interaction sérieuse. De plus, les personnes âgées de 75 ans et plus avaient plus de chances de recevoir une Bz pour une longue période de temps que les personnes âgées de 65-74 ans. Cette étude a montré que la durée d’utilisation des benzodiazépines augmentait avec le nombre de prescripteurs et avec le nombre de pharmacies consultées pendant l’année. Le nombre de pharmacies utilisées a aussi été associé avec la présence d’une ordonnance non appropriée de benzodiazépines pendant la même année. Nos résultats plaident en faveur d’un système de santé plus intégré, incluant une révision régulière des médicaments pris par les personnes âgées.

Keywords

épidémiologiel’utilisation des benzodiazépinesvieillissementepidemiologybenzodiazepine useaging
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 31 , Issue 3 , September 2012 , pp. 313 - 322
Copyright
Copyright © Canadian Association on Gerontology 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

This study was supported by the Canadian Institutes of Health Research (200403MOP) and by the Fonds de la recherche en santé du Québec (FRSQ-Conseil du medicament: 051719). The authors thank members of the Scientific Committee of the ESA Study (Étude sur la Santé des Aïnés) for the significant scientific advice they provided, and Bernadette Wilson, who provided editing comments.

References

Aguilera, D.C. (1995). Intervention en situation de crise: Théorie et méthodologie [Crisis intervention: Theory and methodology]. Paris, France: InterEditions.Google Scholar
Allain, H., Bentue-Ferrer, D., Polard, E., Akwa, Y., & Patat, A. (2005). Postural instability and consequent falls and hip fractures associated with use of hypnotics in the elderly: A comparative review. Drugs and Aging, 22(9), 749–765.CrossRefGoogle Scholar
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders DSM-IV. (4th Ed.). Washington, DC: American Psychiatric Association.Google Scholar
Ankri, J., Collin, J., Pérodeau, G., & Beaufils, B. (2002). Médicaments psychotropes et sujets âgés: une problématique commune France-Québec [Psychotropic drugs and elderly: the same problem in France and Quebec]. Sciences sociales et Santé, 20(1), 35–62.CrossRefGoogle Scholar
Aparasu, R.R., Mort, J.R., & Brandt, H. (2003). Psychotropic prescription use by community-dwelling elderly in the United States. Journal of American Geriatrics Society, 51(5), 671–677.CrossRefGoogle ScholarPubMed
Bartlett, G., Abrahamowicz, M., Tamblyn, R., Grad, R., Capek, R., & du Berger, R. (2004). Longitudinal patterns of new benzodiazepine use in the elderly. Pharmacoepidemiological Drug & Safety, 13(10), 669–682.CrossRefGoogle ScholarPubMed
Ben Amar, M. (2007). La polyconsommation de psychotropes et les principales interactions pharmacologiques associées. [Poly- psychotropic drug use and its main associated pharmacological interactions ]Centre Québécois de lutte aux dépendances [Addiction prevention Center]. Comité permanent de lutte à la toxicomanie [Addiction prevention Committee], p. 30.Google Scholar
Bierman, E.J., Comijs, H.C., Gundy, C.M., Sonnenberg, C., Jonker, C., & Beekman, A.T. (2007). The effect of chronic benzodiazepine use on cognitive functioning in older persons: Good, bad or indifferent? International Journal of Geriatric Psychiatry, 22(12), 1194–1200.CrossRefGoogle ScholarPubMed
Bolton, J.M., Metge, C., Lix, L., Prior, H., Sareen, J., & Leslie, W.D. (2008). Fracture risk from psychotropic medications: A population-based analysis. Journal of Clinical Psychopharmacology, 28(4), 384–391.CrossRefGoogle ScholarPubMed
Chung, K.F., Cheung, R.C., & Tam, J.W. (1999). Long-term benzodiazepine users–characteristics, views and effectiveness of benzodiazepine reduction information leaflet. Singapore Medical Journal, 40(3), 138–143.Google ScholarPubMed
Collège des Médecins du Québec. (1997). L’utilisation prolongée des benzodiazépines [Long-term use of benzodiazepines]. Le Collège; XXXVIL(3), 23. Retrieved fromhttp://www.cmq.org/DocumentLibrary/UploadedContents/CmsDocuments/lignesrecommandationbzd.pdf.Google Scholar
Conseil Consultatif de Pharmacologie. (1997). L’utilisation appropriée des benzodiazépines chez les personnes âgées [Appropriate use of benzodiazepines in older adults]. Info-médicament personnes âgées, Gouvernement du Québec, 7,1–16.Google Scholar
Crum, R.M., Anthony, J.C., Basset, S.S., & Folstein, M.F. (1993). Population-based norms for the mini-mental state examination by age and educational level. Journal of American Medical Association, 269(18), 2386–2391.CrossRefGoogle Scholar
Cumming, R.G., & Le Couteur, D.G. (2003). Benzodiazepines and risk of hip fractures in older people: A review of the evidence. Central Nervous System Drugs, 17(11), 825–837.Google ScholarPubMed
Dealberto, M.J., Seeman, T., McAvay, G.J., & Berkman, L. (1997). Factors related to current and subsequent psychotropic drug use in an elderly cohort. Journal of Clinical Epidemiology, 50(3), 357–364.CrossRefGoogle Scholar
Egan, M., Moride, Y., Wolfson, C., & Monette, J. (2000). Long-term continuous use of benzodiazepines by older adults in Quebec: Prevalence, incidence and risk factors. Journal of American Geriatrics Society, 48(7), 811–816.CrossRefGoogle ScholarPubMed
Fick, D.M., Waller, J.L., Maclean, J.R., Vanden Heuvel, R., Tadlock, J.G., Gottlieb, M., et al. . (2001). Potentially inappropriate medication use in a medicare managed care population: Association with higher costs and utilization. Journal of Managing Care Pharmacology, 7(5), 407–413.CrossRefGoogle Scholar
Gleason, P.P., Schulz, R., Smith, N.L., Newsom, J.T., Kroboth, P.D., Kroboth, F.J., et al. . (1998). Correlates and prevalence of benzodiazepine use in community-dwelling elderly. Journal of General International Medicine, 13(4), 243–250.CrossRefGoogle ScholarPubMed
Gray, S.L., LaCroix, A.Z., Blough, D., Wagner, E.H., Koepsell, T.D., & Buchner, D. (2002). Is the use of benzodiazepines associated with incident disability? Journal of American Geriatrics Society, 50(6), 1012–1018.CrossRefGoogle ScholarPubMed
Gray, S.L., LaCroix, A.Z., Hanlon, J.T., Penninx, B.W., Blough, D.K., Leveille, S.G., et al. . (2006). Benzodiazepine use and physical disability in community-dwelling older adults. Journal of American Geriatrics Society, 54(2), 224–230.CrossRefGoogle ScholarPubMed
Grymonpre, R.E., Mitenko, P.A., Sitar, D.S., Aoki, F.Y., & Montgomery, P.R. (1988). Drug-associated hospital admissions in older medical patients. Journal of American Geriatrics Society, 36(12), 1092–1098.CrossRefGoogle ScholarPubMed
Hanlon, J.T., Schmader, K.E., Boult, C., Artz, M.B., Gross, C.R., Fillenbaum, G.G., et al. . (2002). Use of inappropriate prescription drugs by older people. Journal of American Geriatrics Society, 50(1), 26–34.CrossRefGoogle ScholarPubMed
Hosmer, D.W., & Lemeshow, S. (1989). Applied logistic regression. New York: John Wiley & Sons.Google Scholar
Institut de la Statistique du Québec. (2005). Lexique du système du code géographique du Québec [Glossary of the system of geographical codes in Quebec] Québec, Gouvernement du Québec.Google Scholar
Isacson, D. (1997). Long-term benzodiazepine use: Factors of importance and the development of individual use patterns over time–a 13-year follow-up in a Swedish community. Social Science in Medicine, 44(12), 1871–1880.CrossRefGoogle Scholar
Kassam, A., & Patten, S.B. (2006). Canadian trends in benzodiazepine and zopiclone use. Canadian Journal of Clinical Pharmacology, 13(1), 121–127.Google Scholar
Keri Yang, H.W., Simoni-Wastila, L., Zuckerman, I.H., & Stuart, B. (2008). Benzodiazepine use and expenditures for medicare beneficiaries and the implications of medicare part D exclusions. Psychiatric Services, 59(4), 384–391.CrossRefGoogle Scholar
Landi, F., Onder, G., Cesari, M., Barillaro, C., Russo, A., Bernabei, R., et al. . (2005). Psychotropic medications and risk for falls among community-dwelling frail older people: An observational study. Journal of Gerontology Series A: Biological Sciences and Medical Sciences, 60(5), 622–626.CrossRefGoogle Scholar
Lechevallier, N., Fourrier, A., & Berr, C. (2003). Utilisation de benzodiazépines chez le sujet âgé: données de la cohorte EVA [Use of benzodiazepines in older adults: Data from the EVA cohort]. Revue épidémiologique de Santé publique, 51(3), 317–326.Google Scholar
Luijendijk, H.J., Tiemeier, H., Hofman, A., Heeringa, J., & Stricker, B.H. (2008). Determinants of chronic benzodiazepine use in the elderly: A longitudinal study. British Journal of Clinical Pharmacology, 65(4), 593–599.CrossRefGoogle ScholarPubMed
McLeod, P.J., Huang, A.R., Tamblyn, R.M., & Gayton, D.C. (1997). Defining inappropriate practices in prescribing for elderly people: A national consensus panel. Canadian Medical Association Journal, 156(3), 385–391.Google ScholarPubMed
Morgan, K., Dallosso, H., Ebrahim, S., Arie, T., & Fentem, P.H. (1988). Prevalence, frequency, and duration of hypnotic drug use among the elderly living at home. British Medical Journal (Clinical Research Edition), 296(6622), 601–602.CrossRefGoogle Scholar
Mort, J.R., & Aparasu, R.R. (2000). Prescribing potentially inappropriate psychotropic medications to the ambulatory elderly. Archives of Internal Medicine, 160(18), 2825–2831.CrossRefGoogle Scholar
Panneman, M.J., Goettsch, W.G., Kramarz, P., & Herings, R.M. (2003). The costs of benzodiazepine-associated hospital-treated fall injuries in the EU: A Pharmo study. Drugs and Aging, 20(11), 833–839.CrossRefGoogle Scholar
Pepper, G.A. (1999). Drug use and misuse. In Stone, J.T., Wyman, J.F., & Salisbury, S.A. (Eds.), Clinical Gerontological Nursing, A Guide to Advanced Practice. Montréal, Quebec, Canada: Saunders.Google Scholar
Pérodeau, G., Jomphe Hill, A., Hay-Paquin, L., & Amyot, E. (1996). Les psychotropes et le vieillissement normal: une perspective psychosociale et socioéconomique [Psychotropic drugs and normal aging: A psychosocial and socioeconomic perspective]. Canadian Journal of Aging, 15(4), 559–582.CrossRefGoogle Scholar
Préville, M., Boyer, R., Grenier, S., Dubé, M., Voyer, P., Punti, R., et al. . (2008). The epidemiology of psychiatric disorders in Quebec’s older adult population. Canadian Journal of Psychiatry, 53(12), 822–832.CrossRefGoogle ScholarPubMed
Préville, M., Hébert, R., Boyer, R., & Bravo, G. (2001). Correlates of psychotropic drug use in the elderly compared to adults aged 18–64: Results from the Quebec Health Survey. Aging and Mental Health, 5(3), 216–224.CrossRefGoogle ScholarPubMed
Rancourt, C., Moisan, J., Baillargeon, L., Verreault, R., Laurin, D., & Grégoire, J.P. (2004). Potentially inappropriate prescriptions for older patients in long-term care. BioMed Central Geriatrics, 4, 9.Google ScholarPubMed
Régie de l’assurance maladie du Québec (RAMQ). (2001). Portrait quotidien de la consommation médicamenteuse des personnes âgées non hébergées, Gouvernement du Québec. Retrieved fromhttp://www.ramq.gouv.qc.ca/fr/publications/documents/depliantscitoyens/consom.pdf.Google Scholar
Riska, E., & Klaukka, T. (1984). Use of psychotropic drugs in Finland. Social Science in Medicine, 19(9), 983–989.CrossRefGoogle Scholar
Roberts, A.R. (2002). Assessment, crisis intervention, and trauma treatment: The integrative ACT intervention model. Brief Treatment in Crisis Intervention, 2(1), 1–21.CrossRefGoogle Scholar
Robitaille, L., Courchesne, M., Sylvain, J., & Vadnais, M. (1991). Anxiolytiques et hypnotiques [Anxiolytics and hypnotics]. In Barbeau, G., Guimond, J., & Mallet, L. (Eds.), Médicaments et personnes âgées (pp. 257–274). Canada: Edisem et Maloine.Google Scholar
Souchet, E., Lapeyre-Mestre, M., & Montastruc, J.L. (2005). Drug related falls: A study in the French pharmacovigilance database. Pharmacoepidemiology and Drug Safety, 14(1), 11–16.CrossRefGoogle Scholar
Swartz, M., Landerman, R., George, L.K., Melville, M.L., Blazer, D., & Smith, K. (1991). Benzodiazepine anti-anxiety agents: Prevalence and correlates of use in a southern community. American Journal of Public Health, 81(5), 592–596.CrossRefGoogle Scholar
Tamblyn, R. (1996). Medication use in seniors: Challenges and solutions. Therapy, 51(3), 269–282.Google ScholarPubMed
Tamblyn, R.M., McLeod, P.J., Abrahamowicz, M., Monette, J., Gayton, D.C., Berkson, L., et al. . (1994). Questionable prescribing for elderly patients in Quebec. Canadian Medical Association Journal, 150(11), 1801–1809.Google ScholarPubMed
Tatro, D.S., & Hartshorn, E.A. (2001). Drug interaction facts on disc. St Louis, MO: Facts and Comparisons Inc.Google Scholar
Voyer, P., Cappeliez, P., Pérodeau, G., & Préville, M. (2005). Mental health for older adults and benzodiazpine use. Journal of Community Health Nursing, 22(4), 213–229.CrossRefGoogle Scholar
Voyer, P., McCubbin, M., Cohen, D., Lauzon, S., Collin, J., & Boivin, C. (2004). Unconventional indicators of drug dependence among elderly long-term users of benzodiazepines. Issues in Mental Health Nursing, 25(6), 603–628.CrossRefGoogle ScholarPubMed
Voyer, P., Préville, M., Roussel, M.E., Berbiche, D., & Beland, S.G. (2009). Factors associated with benzodiazepine dependence among community-dwelling seniors. Journal of Community Health Nursing, 26(3), 101–113.CrossRefGoogle ScholarPubMed
Wagner, A.K., Zhang, F., Soumerai, S.B., Walker, A.M., Gurwitz, J.H., Glynn, R.J., et al. . (2004). Benzodiazepine use and hip fractures in the elderly: Who is at greatest risk? Archives of Internal Medicine, 164(14), 1567–1572.CrossRefGoogle ScholarPubMed
Woolcott, J.C., Richardson, K.J., Wiens, M.O., Patel, B., Marin, J., Khan, K.M., et al. . (2009). Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Archives of Internal Medicine, 169(21), 1952–1960.CrossRefGoogle Scholar