Outcome of new benzodiazepine prescriptions to older adults in primary care

Gen Hosp Psychiatry. Sep-Oct 2006;28(5):374-8. doi: 10.1016/j.genhosppsych.2006.05.008.

Abstract

Objective: The objective of this study was to examine the indications for benzodiazepine use, and the baseline characteristics, duration of use and clinical outcomes of older primary care patients prescribed benzodiazepines.

Methods: Computerized records were used to identify outpatients (n=129) aged >or=60 years who received new benzodiazepine prescriptions from primary care physicians of a group model managed care organization. A baseline telephone survey assessed indications for prescription, sleep quality (Pittsburgh Sleep Quality Index), depression (Symptom Checklist depression scale and Structured Clinical Interview for DSM-IV), alcohol use (CAGE) and functional status (SF-36). A 2-month follow-up survey assessed benzodiazepine use, sleep quality and depression.

Results: The most common indications for prescription were insomnia (42%) and anxiety (36%). At baseline, participants reported moderate sleep disturbance (mean Pittsburgh Sleep Quality Index=9.3, S.D.=4.0), only 15% met criteria for current depressive episode and only 3% reported at-risk alcohol use. After 2 months, 30% of participants used benzodiazepines at least daily. Both those continuing daily use and those not continuing daily use reported significant improvements in sleep quality and depression, with no difference between groups in rates of improvement.

Conclusions: Initial benzodiazepine prescriptions to older adults are typically intended for the treatment of anxiety or insomnia, with little evidence for occult depression or alcohol abuse. A significant minority develops a pattern of long-term use, raising concerns about tolerance and dependence.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Alcohol Drinking / adverse effects
  • Alcohol Drinking / epidemiology
  • Anxiety Disorders / diagnosis
  • Anxiety Disorders / drug therapy
  • Anxiety Disorders / epidemiology
  • Benzodiazepines / adverse effects
  • Benzodiazepines / therapeutic use*
  • Cohort Studies
  • Comorbidity
  • Depressive Disorder / diagnosis
  • Depressive Disorder / drug therapy
  • Depressive Disorder / epidemiology
  • Drug Administration Schedule
  • Drug Prescriptions* / statistics & numerical data
  • Female
  • Humans
  • Hypnotics and Sedatives / adverse effects
  • Hypnotics and Sedatives / therapeutic use*
  • Long-Term Care
  • Male
  • Managed Care Programs
  • Middle Aged
  • Outcome Assessment, Health Care* / statistics & numerical data
  • Pain / diagnosis
  • Pain / drug therapy
  • Pain / epidemiology
  • Primary Health Care* / statistics & numerical data
  • Retrospective Studies
  • Sleep Initiation and Maintenance Disorders / diagnosis
  • Sleep Initiation and Maintenance Disorders / drug therapy
  • Sleep Initiation and Maintenance Disorders / epidemiology
  • Washington

Substances

  • Hypnotics and Sedatives
  • Benzodiazepines