title: Elderly benzodiazepine users at increased risk of activity limitations: influence of chronicity, indications, and duration of action--the three-city cohort.
abstract: OBJECTIVE
  To examine the cross-sectional and longitudinal associations between benzodiazepine use and daily activity limitations, according to drug indications and duration of action.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Population-based three-city study.
  
  
  METHODS
  6,600 participants aged 65 years and over included between 1999 and 2001 and followed after 2, 4, and 7 years.
  
  
  METHODS
  Benzodiazepine users were separated into hypnotic, short-acting anxiolytic, and long-acting anxiolytic users and compared with non users. Three outcomes were examined assessing restrictions in mobility, instrumental activities of daily living (IADLs) and social participation.
  
  
  RESULTS
  In multivariate simple or mixed logistic models adjusted for sociodemographic variables, impairments and comorbidity, and for anxiety, insomnia, and depression, hypnotic benzodiazepines were moderately associated with mobility limitation prevalence and IADL limitation incidence. Short-acting and long-acting anxiolytics were associated with IADL limitation prevalence and with mobility limitation prevalence and incidence and long-acting anxiolytics were also associated with IADL limitation incidence. Chronic benzodiazepines users were at a marked risk of developing restrictions for the three outcomes; odds ratio: 1.71 (95% CI: 1.23-2.39) for mobility, 1.54 (95% CI: 1.14-2.10) for IADL, and 1.74 (95% CI: 1.23-2.47) for participation limitations.
  
  
  CONCLUSIONS
  Benzodiazepine users are at increased risk of activity limitations regardless of the duration of action or indication. Chronic use of benzodiazepines should be avoided in order to extend disability-free survival.
authors.affiliation: INSERM U1061, Montpellier, France; Université Montpellier I, U1061, Montpellier, France. Electronic address: isabelle.carriere@inserm.fr.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Carrière
authors.affiliation: INSERM U1061, Montpellier, France; Université Montpellier I, U1061, Montpellier, France.
authors.forename: Thibault
authors.initials: T
authors.lastname: Mura
authors.affiliation: INSERM ISPED, Centre Inserm U897-Epidemiologie-Biostatistique, Bordeaux, France; Université Bordeaux, ISPED, Centre Inserm U897-Epidemiologie-Biostatistique, Bordeaux, France.
authors.forename: Karine
authors.initials: K
authors.lastname: Pérès
authors.affiliation: INSERM U1061, Montpellier, France; Université Montpellier I, U1061, Montpellier, France.
authors.forename: Joanna
authors.initials: J
authors.lastname: Norton
authors.affiliation: INSERM U1061, Montpellier, France; Université Montpellier I, U1061, Montpellier, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Jaussent
authors.affiliation: INSERM ISPED, Centre Inserm U897-Epidemiologie-Biostatistique, Bordeaux, France; Université Bordeaux, ISPED, Centre Inserm U897-Epidemiologie-Biostatistique, Bordeaux, France.
authors.forename: Arlette
authors.initials: A
authors.lastname: Edjolo
authors.affiliation: CHRU Dijon, Centre Mémoire Ressources et Recherche, Dijon, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Rouaud
authors.affiliation: INSERM U1061, Montpellier, France; Université Montpellier I, U1061, Montpellier, France.
authors.forename: Claudine
authors.initials: C
authors.lastname: Berr
authors.affiliation: INSERM U1061, Montpellier, France; Université Montpellier I, U1061, Montpellier, France; Faculty of Medicine, Imperial College, London, United Kingdom.
authors.forename: Karen
authors.initials: K
authors.lastname: Ritchie
authors.affiliation: INSERM U1061, Montpellier, France; Université Montpellier I, U1061, Montpellier, France.
authors.forename: Marie Laure
authors.initials: ML
authors.lastname: Ancelin
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D014151:Anti-Anxiety Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000188:drug therapy; D001569:Benzodiazepines / Q000009:adverse effects* / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D005260:Female; D005602:France; D006801:Humans; D016015:Logistic Models; D008297:Male; D051346:Mobility Limitation; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D058992:Social Participation
chemical_list: D014151:Anti-Anxiety Agents; D001569:Benzodiazepines
keywords: Benzodiazepines; activity of daily living; aging; longitudinal study; random-effect model