WASHINGTON – Chronic benzodiazepine use by the elderly does not necessarily lead to an increased risk of death, hospital readmission, institutionalization, or functional decline, Christophe J. Bula, M.D., said at the annual meeting of the Gerontological Society of America.
Dr. Bula of Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland, and his colleagues studied 304 patients admitted from the emergency department to the internal medicine department of an academic hospital over a 6-month period.
They found that the patients who were chronic users of benzodiazepines were no more likely to die, to be readmitted to the hospital, to be admitted to a nursing home, or to experience functional decline than were the nonchronic users.
Patients were included in the study if they were 75 years or older, lived in the community, had a hospital stay of at least 12 hours, and had basic insurance. At baseline, patients underwent a bedside interview and a geriatric assessment–including cognitive, affective, and physical components–by a trained research nurse. Utilization data (hospital and nursing home admissions) were obtained from the state centralized billing office records.
The patients were followed with a phone interview at 3 months and a home visit at 6 months. The home visit involved the same interview and assessment as at baseline, Dr. Bula said.
For this study, benzodiazepines included any drug from groups N05B (anxiolytics) and N05C (hypnotics and sedatives) of the Anatomical Therapeutic Chemical classification system. Chronic use was defined as self-reported use at least three times per week in the previous month. The validity of this definition was assessed in a small subgroup by repeating the drug use portion of the interview and by urine analysis. Both showed good agreement.
Almost half (45%) of the patients were chronic users of benzodiazepines. Following multivariate analysis, chronic users were more likely to be women (OR 2.4), to have a high school education (OR 1.9), to have in-home help (OR 2.3), and to have depressive symptoms (OR 1.7).
“We think that the baseline differences between chronic benzodiazepine users and the others suggest a strong prescribing bias, where practitioners seem to avoid prescribing benzodiazepines to the frailest elderly,” Dr. Bula said at the meeting.
Interestingly, chronic users were more likely to improve their cognitive performance at 6 months (adjusted OR 2.4). Improved cognition among chronic users suggests a temporary impairment in cognitive performance at hospitalization, he said.
“This could be consistent with what we know about the increased risk of chronic users to become delirious when they are hospitalized,” he noted.