What is the point of guidelines? Benzodiazepine and z-hypnotic use by an elderly population.
BACKGROUND
According to published guidelines regarding the use of benzodiazepines or z-hypnotics (BZD-Z), the elderly should avoid hypnotic BZD, and use anxiolytic BZD and z-hypnotics only at low doses and for a short time. Our objective is to quantify inappropriate BZD-Z use in the elderly.


METHODS
The study population consisted of people aged 70-89 who filled at least two prescriptions in 2008 within one of three subgroups: anxiolytic BZD, hypnotics BZD, or z-hypnotics. Inappropriate use criteria used for this study were (1) any hypnotic BZD, (2) exceeding 300 DDD, or a dosage exceeding 9 DDD/week, or anxiolytic BZD and z-hypnotics use exceeding 30 weeks.


RESULTS
118,526 persons, or 25% of elderly Norwegians, filled at least two prescriptions for one of these medication subgroups. Inappropriate use was found for 25% of anxiolytic BZD users, 100% of hypnotic BZD users, and 65% of z-hypnotic users. Altogether 57,276 elderly Norwegians, or 12.3% of the elderly source population, used BZD-Z inappropriately as defined in this study.


CONCLUSIONS
Clearly, inappropriate use of BZD-Z is widespread. An active response to such noncompliance with existing guidelines could consist of either (1) stricter enforcement of guidelines or (2) revamping guidelines through a fresh look at risks, benefits, and treatment practices. The implications of both options are discussed in some detail.
Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada.
C Ineke
CI
Neutel
Svetlana
S
Skurtveit
Christian
C
Berg
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D014151:Anti-Anxiety Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001569:Benzodiazepines / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000627:therapeutic use*; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data; D008297:Male; D009664:Norway; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012737:Sex Factors
D014151:Anti-Anxiety Agents; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines