Benzodiazepine and z-hypnotic prescribing for older people in primary care: a cross-sectional population-based study.
BACKGROUND
Overall prescribing of benzodiazepines and z-hypnotics (B&Zs) has slowly reduced over the past 20 years. However, long-term prescribing still occurs, particularly among older people, and this is at odds with prescribing guidance.


OBJECTIVE
To compare prescribing of B&Zs between care home and non-care home residents ≥65 years old.


METHODS
Cross-sectional population-based study in primary care in Scotland.


METHODS
National patient-level B&Z prescribing data, for all adults aged ≥65 years, were extracted from the Prescribing Information System (PIS) for the calendar year 2011. The PIS gives access to data for all NHS prescriptions dispensed in primary care in Scotland. Data were stratified by health board, residential status, sex, and age (65-74, 75-84, and ≥85 years). To minimise disclosure risk, data from smaller health boards were amalgamated according to geography, thereby reducing the number from 14 to 10 areas.


RESULTS
A total of 17% (n = 879 492) of the Scottish population were aged ≥65 years, of which 3.7% (n = 32 368) were care home residents. In total, 12.1% (n = 106 412) of older people were prescribed one or more B&Z: 5.9% an anxiolytic, 7.5% a hypnotic, and 1.3% were prescribed both. B&Zs were prescribed to 28.4% (9199) of care home and 11.5% (97 213) of non-care home residents (relative risk = 2.88, 95% CI = 2.82 to 2.95, P<0.001). Estimated annual B&Z exposure reduced with increasing age of care home residents, whereas non-care home residents' exposure increased with age.


CONCLUSIONS
B&Zs were commonly prescribed for older people, with care home residents approximately three times more likely to be prescribed B&Zs than non-care home residents. However, overall B&Z exposure among non-care home residents was found to rise with increasing age.
Medicine for the Elderly and Care Homes, Pharmacy and Prescribing Support Unit, West Glasgow Ambulatory Care Hospital, Yorkhill, Glasgow.
Chris F
CF
Johnson
Pharmacy Department, Hirslanden Klinik St Anna, Luzern, Switzerland.
Cornelia
C
Frei
Medicine for the Elderly and Care Homes, Pharmacy and Prescribing Support Unit, West Glasgow Ambulatory Care Hospital, Yorkhill, Glasgow.
Noreen
N
Downes
NHS ational Services Scotland, Information Services Division, Edinburgh.
Stuart A
SA
McTaggart
Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow.
Gazala
G
Akram
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D001007:Anxiety / Q000188:drug therapy* / Q000453:epidemiology; D001569:Benzodiazepines / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data; D008297:Male; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration; D012112:Residential Facilities; D012606:Scotland / Q000453:epidemiology; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D012737:Sex Factors; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy* / Q000453:epidemiology
D014151:Anti-Anxiety Agents; D001569:Benzodiazepines; D006993:Hypnotics and Sedatives; D017367:Selective Serotonin Reuptake Inhibitors
anxiolytics; benzodiazepines; care homes; family practice; hypnotics; older people