Abstract
OBJECTIVE: To describe the prevalence of benzodiazepine use, sociodemographic and physical health factors associated with use, dosages taken, and directions for use among individuals aged 65 years and older.
DESIGN: Cross-sectional analysis of baseline data from the community-based, prospective observational Cardiovascular Health Study.
PATIENTS/PARTICIPANTS: Medicare eligibility lists from four U.S. communities were used to recruit a representative sample of 5,201 community-dwelling elderly, of which 5,181 participants met all study criteria.
MEASUREMENTS AND MAIN RESULTS: Among participants, 511 (9.9%) were taking at least one benzodiazepine, primarily anxiolytics (73%). Benzodiazepines were often prescribed to be taken pro re nata (PRN “as needed”), and 36.5% of prescriptions with instructions to be taken regularly were taken at a dose lower than prescribed. Reported over-the-counter (OTC) sleep aid medication use was 39.2% in benzodiazepine users and 3.3% in nonusers. In a multivariate logistic model, the significant independent correlates of benzodiazepine use were being white (odds ratio [OR] 1.9; 95% confidence interval [CI] 1.0, 3.4), female (OR 1.7; CI 1.4, 2.2), and living in Forsyth County, North Carolina, or Washington County, Maryland, compared with living in Sacramento County, California, or Allegheny County, Pennsylvania (OR 2.3; CI 1.4, 2.2); having coronary heart disease (OR 1.6; CI 1.2, 2.1), health status reported as poor or fair (OR 1.8; CI 1.4, 2.3), self-reported diagnosis of nervous or emotional disorder (OR 6.7; CI 5.1, 8.7), and reporting use of an OTC sleep aid medication (OR 18.7; CI 14.1, 24.7).
CONCLUSIONS: One in 10 participants reported taking a benzodiazepine, most frequently an anxiolytic, often at a lower dose than prescribed and usually PRN. The high prevalence of OTC sleep aid medication and benzodiazepine use may place the patient at increased risk of psychomotor impairment. Physicians should assess OTC sleep aid medication use when prescribing benzodiazepines.
Similar content being viewed by others
References
Gillin JC, Byerley WF. The diagnosis and management of insomnia. N Engl J Med. 1990;322:239–48.
Shader RI, Greenblatt DJ. Use of benzodiazepines in anxiety disorders. N Engl J Med. 1993;328:1398–1405.
Kales A, Bixler EO, Soldatos CR, Vela-Bueno A, Jacoby JA, Kales JD. Quazepam and temazepam: effect of short- and intermediate-term use and withdrawal. Clin Pharmacol Ther. 1986;39:345–52.
Mendelson WB, Weingartner H, Greenblatt DJ, Garnett D, Willin JC. A clinical study of flurazepam. Sleep. 1982;5:350–60.
Cross-National Collaborative Panic Study, Second Phase Investigators. Drug treatment of panic disorder, comparative efficacy of alprazolam, imipramine, and placebo. Br J Psychiatry. 1992;160:191–202.
Rickels K, Schweizer E, Csanalosi I, Case WG, Chung H. Long term treatment of anxiety and risk of withdrawal: prospective comparison of clorazepate and buspirone. Arch Gen Psychiatry. 1988;45:444–50.
Greenblatt DJ, Harmatz JS, Shader RI. Clinical pharmacokinetics of anxiolytics and hypnotics in the elderly. Clin Pharmacokinet. 1991;21:262–73.
Bertz RJ, Kroboth PD, Kroboth FJ, et al. Alprazolam in elderly and young men. Sensitivity and tolerance to psychomotor, sedative and memory effects. J Pharmacol Exp Ther. 1997;281:1317–29.
Greenblatt DJ, Harmatz JS, Shapiro L, Engelhardt N, Gouthro TA, Shader RI. Sensitivity to triazolam in the elderly. N Engl J Med. 1991;324:1691–8.
Smith RB, Divoll M, Gillespie WR, Greenblatt DJ. Effect of subject age and gender on the pharmacokinetics of oral triazolam and temazepam. J Clin Psychopharmacol. 1983;3:172–6.
Greenblatt DJ, Divoll M, Abernethy DR, Ochs HR, Shader RI. Benzodiazepine kinetics: implication for therapeutics and pharmacogeriatrics. Drug Metab Rev. 1983;14:251–92.
Greenblatt DJ, Divoll M, Harmatz JS, McLaughlin DS, Shader RI. Kinetics and clinical effects of flurazepam in young and elderly noninsomniacs. Clin Pharmacol Ther. 1981;30:475–86.
Greenblatt DJ, Allen MD, Shader RI. Toxicity of high-dose flurazepam in the elderly. Clin Pharmacol Ther. 1977;21:355–61.
Kruse WHH. Problems and pitfalls in the use of benzodiazepines in the elderly. Drug Safety. 1990;5:328–44.
Olfson M, Pincus HA. Use of benzodiazepines in the community. Arch Intern Med. 1994;154:1235–40.
Stewart RB, Franklin EM, Moore MT, Hale WE. Changing patterns of psychotropic drug use in the elderly: a five-year update. DICP Ann Pharmacother. 1989;23:610–3.
Wysowski DK, Baum C. Outpatient use of prescription sedative-hypnotic drugs in the United States, 1980 through 1989. Arch Intern Med. 1991;151:1779–83.
Hindmarch I, Kerr JS, Sherwood N. The effects of alcohol and other drugs on psychomotor performance and cognitive function. Alcohol Alcoholism. 1991;26:71–9.
Ellinwood EH Jr, Heatherly DG, Nikaido AM, Bjornsson TD, Kitls C. Comparative pharmacokinetics and pharmacodynamics of lorazepam, alprazolam, and diazepam. Psychopharmacology (Berl). 1985;86:392–9.
Smith RB, Kroboth PD, Vanderlugt JT, Phillips JP, Juhl RP. Pharmacokinetics and pharmacodynamics of alprazolam after oral and IV administration. Psychopharmacology (Berl). 1984;84:452–6.
Linnoila M, Erwin CW, Brendle A, Simpson D. Psychomotor effects of diazepam in anxious patients and healthy volunteers. J Clin Psychopharmacol. 1983;3:88–96.
Hemmelgarn B, Suissa S, Huang A, Boivin JF, Pinard G. Benzodiazepine use and the risk of motor vehicle crash in elderly. JAMA. 1997;278:27–31.
Ray WA, Griffin MR, Downey W. Benzodiazepines of long and short elimination half-life and the risk of hip fracture. JAMA. 1989;262:3303–7.
Granek E, Baker SP, Abbey H, et al. Medications and diagnosis in relation to falls in a long-term care facility. J Am Geriatr Soc. 1987;35:503–11.
Rubenstein LZ, Josephson KR, Robbins AS. Falls in the nursing home. Ann Intern Med. 1994;121:442–51.
Ray WA, Griffin MR, Downey W. Psychotropic drug use and the risk of hip fracture. N Engl J Med. 1987;316:363–9.
Cummings SR, Nevitt MC, Browner WS, et al. Risk factors for hip fracture in white women. N Engl J Med. 1995;332:767–73.
Herings RMC, Stricker BHC, de Boer A, Bakker A, Sturmans F. Benzodiazepines and the risk of falling leading to femur fractures: dosage more important than elimination half-life. Arch Intern Med. 1995;155:1801–7.
Woods JH, Katz JL, Winger G. Benzodiazepines: use, abuse, and consequences. Pharmacol Rev. 1992;44:151–347.
Nolan L, O’Malley K. Patients, prescribing, and benzodiazepines. Eur J Clin Pharmacol. 1988;35:225–9.
Mayer-Oakes SA, Kelman G, Beers MH, et al. Benzodiazepine use in older, community-dwelling southern Californians: prevalence and clinical observations. Ann Pharmacother. 1993;27:416–21.
Swartz M, Landerman R, George LK, Melville ML, Blazer D, Smith K. Benzodiazepine anti-anxiety agents: prevalence and correlates of use in a southern community. Am J Public Health. 1991;81:592–6.
Tell GS, Fried LP, Hermanson B, Manolio TA, Newman AB, Borhani NO. Recruitment of adults 65 years and older as participants in the Cardiovascular Health Study. Ann Epidemiol. 1993;3:358–66.
Landry JA, Smyer MA, Tubman JG, Lago DJ, Roberts J, Simonson W. Validation of two methods of data collection of self-reported medicine use among the elderly. Gerontologist. 1988;28:672–6.
Psaty BM, Lee M, Savage PJ, Rutan GH, German PS, Lyles M. Assessing the use of medications in the elderly: method and initial results in the Cardiovascular Health Study. J Clin Epidemiol. 1992;45:683–92.
Schulz R, Mittelmark M, Kronmal R, et al. Predictors of perceived health status in elderly men and women. J Aging Health. 1994;6:419–47.
Cohen S, Mermelstein R, Kamarack T, Hoberman HM. Measuring the functional components of social support. In: Sarason IG, Sarason BR, eds. Social Support: Theory, Research, and Applications. The Hague, Netherlands: Martinus Nijhoff; 1985:73–94.
Katz SC, Ford AB, Moskowitz RW, et al. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA. 1963;185:914–9.
Lawton MP, Brod EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9:179–86.
Hosmer DW, Lemeshow S, eds., Applied Logistic Regression. New York, NY: Wiley and Sons; 1989.
Simons FE, Simons KJ. The pharmacology and use of H1-receptorantagonist drugs. N Engl J Med. 1994;330:1663–70.
Simons FER. H1-receptor-antagonists: comparative tolerability and safety. Drug Safety. 1994;10:350–80.
Lamy P. Over-the-counter medications: the drug interactions we overlook. J Am Geriatr Soc. 1982;30:S69.
Kupfer DJ, Reynolds CF. Management of insomnia. New Engl J Med. 1997;336:341–6.
Jiang W, Babyak M, Krantz DS, et al. Mental stress-induced myocardial ischemia and cardiac events. JAMA. 1996;275:1651–6.
Reich J. The epidemiology of anxiety. J Nerv Ment Dis. 1986;174:129–36.
Chassin MR, Brook RH, Park RE, et al. Variations in the use of medical and surgical services by the medicare population. N Engl J Med. 1986;314:285–90.
Gilbert K, Gleason PP, Singer DE, et al. Variations in antimicrobial use and costs in more than 2000 patients with community-acquired pneumonia. Am J Med. 1998;104:17–27.
Mort EA. Clinical decision-making in the face of scientific uncertainty: hormone replacement therapy as an example. J Fam Pract. 1996;42:147–51.
Author information
Authors and Affiliations
Additional information
Supported by contracts N01-HC-85079 through N01-HC-85086, from the National Heart, Lung, and Blood Institute, grants AG-09556 and AG13305 from the National Institute on Aging, and grants MH46015 and MH52247 from the National Institutes of Mental Health.
Rights and permissions
About this article
Cite this article
Gleason, P.P., Schulz, R., Smith, N.L. et al. Correlates and prevalence of benzodiazepine use in community-dwelling elderly. J GEN INTERN MED 13, 243–250 (1998). https://doi.org/10.1046/j.1525-1497.1998.00074.x
Issue Date:
DOI: https://doi.org/10.1046/j.1525-1497.1998.00074.x