Determinants of chronic benzodiazepine use in the elderly: a longitudinal study.
BACKGROUND
* The risk of adverse events due to chronic benzodiazepine use is high in the elderly. * Cross-sectional studies have shown that increasing age, female gender and poor physical and mental health are associated with benzodiazepine use. * When users were re-examined some years later, chronic somatic disease, pain and stress seemed to contribute to the continuation of benzodiazepine use.


CONCLUSIONS
* This is the first longitudinal study that analyzed the determinants of new-onset chronic benzodiazepine use in community-dwelling elderly. * Symptoms of depression, hypertension, pain related joint complaints and the perception of poor physical health predicted new-onset chronic use. Living alone was found to decrease the risk of chronic use.


OBJECTIVE
The risk of adverse events due to chronic benzodiazepine use is high in the elderly. Clinicians need to be able to identify those persons who are at risk of chronic benzodiazepine use, but little is known about the determinants. This study determined social and health related factors that predict new-onset chronic benzodiazepine use in community-dwelling elderly.


METHODS
This study was embedded in an ongoing cohort study among 5364 persons aged >or=57 years. Drug-dispensing medication records were available for the period between 1991 and 2003. We defined chronic benzodiazepine use as use during at least 180 days in a period of 365 consecutive days. The association of various social, psychiatric and somatic variables with new-onset chronic benzodiazepine use was studied with a Cox proportional hazards analysis.


RESULTS
Symptoms of depression, hypertension, pain related joint complaints and the perception of poor physical health predicted new-onset chronic use. In the subsample of participants who had filled at least one prescription in the follow-up period, of these variables only pain related joint complaints increased the risk of new-onset chronic use. Living alone protected against chronic benzodiazepine use.


CONCLUSIONS
The elderly with poor mental and physical health are at an increased risk of chronic benzodiazepine use. Living alone was found to decrease the risk of chronic use, which suggests that social factors may determine drug usage patterns. Very few characteristics predicted chronic benzodiazepine use once patients had received their first prescription. For clinicians, identification of patients at high risk is therefore not straightforward.
Luijendijk
Hendrika J
HJ
Erasmus Medical Centre, Department of Epidemiology and Biostatistics, Rotterdam, The Netherlands.
Tiemeier
Henning
H
Hofman
Albert
A
Heeringa
Jan
J
Stricker
Bruno H Ch
BH
D000368:Aged; D014151:Anti-Anxiety Agents / Q000009:adverse effects*; D001569:Benzodiazepines / Q000009:adverse effects*; D015331:Cohort Studies; D003863:Depression / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010146:Pain / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D016016:Proportional Hazards Models; D012111:Residence Characteristics; D018570:Risk Assessment / Q000592:standards; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors
D014151:Anti-Anxiety Agents; D001569:Benzodiazepines