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1 in 4 older adults prescribed benzodiazepines transition to long-term use
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A quarter of older adults who were newly prescribed a benzodiazepine went on to long-term use, with factors such as white race and poor sleep quality increasing the risk, according to findings published in JAMA Internal Medicine.
“Long-term use of benzodiazepines can place older adults in particular at risk for concerning side effects such as falls and cognitive impairment,” Lauren B. Gerlach, DO, from the University of Michigan Medical School, Ann Arbor, told Healio Internal Medicine.
Gerlach and colleagues assessed the transition from new to long-term use of benzodiazepines among older adults to determine factors associated with the conversion to long-term use. A total of 576 older adults (mean age, 78.4 years) newly prescribed a benzodiazepine by a nonpsychiatric clinician were included and evaluated for depression, anxiety, sleep quality and pain.
The researchers defined long-term benzodiazepine use as having a 30% or greater medication possession ratio in the year after the initial prescription.
Data showed that one in four participants transitioned to long-term users of benzodiazepines (n = 152). Long-term users were prescribed a mean of 232.7 benzodiazepine days. Whites (OR = 4.19; 95% CI, 1.51-11.59), those with poor sleep quality (OR = 4.05; 95% CI, 1.44-11.43) and those with more days supplied in the index period (OR = 1.94; 95% CI, 1.52-2.47) were more likely to use benzodiazepines for a longer period. Anxiety, depression and pain were not predictors of continued benzodiazepine use.
The risk for long-term use nearly doubled for each 10 additional days that the medication was prescribed, according to Gerlach.
“The decision to prescribe and then continue a benzodiazepine — or any other medical treatment — should be driven by a clinical need,” Gerlach said. “It is concerning that we found that nonclinical factors, such as patient race and supply of initial prescription, were strongly associated with long-term use.”
“Our and others’ findings that a larger number of pills provided in the initial prescription is associated with conversion to long-term use suggests that providers should pause and think more cautiously when providing a new prescription for a benzodiazepine — such as considering a 14-day supply rather than a 30-day supply of medication,” she added.
Gerlach emphasized that more research and work is required to better understand the patient and provider factors that drive prescribing practices and improve access to education regarding effective nonpharmacologic treatments, including cognitive behavioral therapy. Health care providers should also be educated on tapering strategies, she said.
“The results of our study show that we need to help providers ‘start with the end in mind’ when prescribing a benzodiazepine, by beginning with a short-duration prescription and engaging patients in discussions of when to re-evaluate their symptoms and begin tapering the patient off,” Gerlach said. “Since chronic benzodiazepine use is rarely the goal when a new benzodiazepine is started, clinicians may decrease the likelihood of long-term use by limiting the amount of medication they provide in that initial prescription.” – by Alaina Tedesco
Disclosure: The authors report no relevant financial disclosures.