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Benzodiazepine Use in Older Adults Enrolled in a Health Maintenance Organization

Received October 24, 2002; revised January 29, 2003; accepted February 6, 2003. From the University of Washington, School of Pharmacy, Seattle, WA (SLG,DB), Department of Pharmacoepidemiology and Pharmacy Practice, University of Tromsø, Norway (AEE), Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, WA (D.Buchner), and the Department of Epidemiology, University of Washington, Seattle, and Center for Health Studies, Group Health Cooperative of Puget Sound (AZL). Send correspondence to Dr. Shelly L. Gray, University of Washington, School of Pharmacy, Box 357630, Seattle, WA 98195. e-mail: slgray{at}u.washington.edu

Objectives: The authors examined patterns of benzodiazepine use in older adults. Specifically, they describe prevalence and incidence of benzodiazepine use during the index year, describe persistence and intensity of benzodiazepine use over a 4-year period; and examine factors associated with benzodiazepine use in the upcoming year. Methods: Authors performed a secondary analysis of data collected as part of a health promotion intervention trial conducted from 1986 to 1992 in older health maintenance organization enrollees (N=1,505). Benzodiazepine use was ascertained from computerized pharmacy records. Demographic characteristics, health status, and health behaviors were ascertained from mailed questionnaires. Results: During the index year, the prevalence and incidence of benzodiazepine use was 12.3% and 6.6%, respectively. Of those using during the index year, 16% of new users and 63% of previous users continued to use for the following 3 years. The factors significantly associated with benzodiazepine use in the following year were female gender, high school education, higher chronic disease score, higher levels of self-reported pain and stress, low-to-normal body mass index (BMI), and self-reported nervous disorder. Conclusions: New users had low intensity of use and a low probability of continuing use over the following 3 years. A very small percentage of this sample had evidence of daily use for 4 years. Of concern, benzodiazepines were used by the segment of the sample that were at greatest risk for hip fractures (women with normal/low BMI). Clinicians should assess the need for continued benzodiazepine use at regular intervals.

Key Words: Benzodiazepines • Managed Care

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