title: Benzodiazepine use in Belgian nursing homes: a closer look into indications and dosages.
abstract: OBJECTIVE
  (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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Heymans Institute of Pharmacology, Ghent University, De Pintelaan 185 (1 blok B), 9000 Ghent, Belgium. jolyce.bourgeois@hotmail.com
authors.forename: Jolyce
authors.initials: J
authors.lastname: Bourgeois
authors.forename: Monique M
authors.initials: MM
authors.lastname: Elseviers
authors.forename: Majda
authors.initials: M
authors.lastname: Azermai
authors.forename: Luc
authors.initials: L
authors.lastname: Van Bortel
authors.forename: Mirko
authors.initials: M
authors.lastname: Petrovic
authors.forename: Robert R
authors.initials: RR
authors.lastname: Vander Stichele
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014151:Anti-Anxiety Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001007:Anxiety / Q000188:drug therapy*; D001530:Belgium; D001569:Benzodiazepines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003248:Constipation / Q000139:chemically induced; D003430:Cross-Sectional Studies; D003863:Depression / Q000139:chemically induced; D004363:Drug Utilization; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009735:Nursing Homes; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011595:Psychomotor Agitation / Q000188:drug therapy; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy*
chemical_list: D014151:Anti-Anxiety Agents; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines