Benzodiazepine use in an elderly community-dwelling population: Characteristics of users and factors associated with subsequent use
Abstract
Objectives The objective of this study was to describe determinants of current and subsequent benzodiazepine use in an elderly population, the Paquid cohort.Methods The study was conducted on a cohort of 2,792 community-dwelling subjects 65 years of age or more living in the Gironde department, southwestern France. Benzodiazepine use and its correlates were studied with data collected at inclusion in the cohort. Longitudinal analysis over a 5-year period of follow-up was done to identify baseline predictors of subsequent use.Results At baseline, prevalence rate of benzodiazepine use was 31.9%. It was associated with female gender [odds ratio (OR) = 2.0; 95% confidence interval (CI): 1.66, 2.46], previous psychiatric disease (OR = 2.87; 95% CI: 2.31, 3.56), concomitant antidepressant use (OR = 2.45; 95% CI: 1.59, 3.78), depressive symptomatology (OR = 1.70; 95% CI: 1.28, 2.26), multiple drug use (OR = 1.82; 95% CI: 1.50, 2.21), multiple chronic diseases (OR = 1.37; 95% CI: 1.12, 1.67) and poor self-perceived health (OR = 1.63; 95% CI: 1.33, 2.0). For the 1926 benzodiazepine non-users at inclusion and followed during 5 years, incidence rate of subsequent use was 5.37 per 100 person-years (95% CI: 4.76, 5.98). In multivariate Cox proportional hazards regression analysis, previous psychiatric diseases, poor self-perceived life satisfaction and polymorbidity were significantly associated with subsequent benzodiazepine use.Conclusions Elderly people are heavy users of benzodiazepines. Independently from mental health status, those in poor health were most at risk of benzodiazepine use.
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One in three people over age 65 consume benzodiazepines regularly.
“Moreover, one in three people over age 65 consume them regularly [15].”
From Cognitive behavioral therapy and acceptance and commitment therapy for the discontinuation of long-term benzodiazepine use in insomnia and anxiety disorders (2021) · cites this paper as [15]
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Self-citationIs there really a link between benzodiazepine use and the risk of dementia?
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“2 Comparability If cases and controls were made comparable for variables such as age and sex in all studies, some putative confounders, that is, strongly linked to benzodiazepine use [31] and dementia [32], were not controlled for by several studies such as educational level (Billioti de Gage et al.”
BackgroundSelf-citationBenzodiazepines and risk of all cause mortality in adults: cohort study
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“The prevalence of use for benzodiazepines alone among patients aged 65 years is estimated to be 30% in France, 20% in Canada and Spain, and approximately 15% in Australia [2–5].”
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Abrahamowicz, M., Bartlett, G., Tamblyn, R. M., & du Berger, R. (2006) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2005.01.021 · Cited by 88 · see citing works
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“…among the home-dwelling elderly has ranged from 10% to 38%, and hypnotics/sedatives (mostly benzodiazepines) have been the most commonly prescribed psychotropics, ranging from 6% to 31% (Laukkanen et al., 1992; Manela et al., 1996; Weiner et al., 1998; Kirby et al., 1999; Fourrier et al., 2001).”
BackgroundIS THERE A RATIONALE FOR PRESCRIPTION OF BENZODIAZEPINES IN THE ELDERLY? REVIEW OF THE LITERATURE
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“In comparison, current prevalence of BZD use in the community setting among the elderly varies between 10 and 37 % (52, 55).”
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“Also, BZDs have been associated with concomitant use of other psychotropics (Kirby et al., 1999; Fourrier et al., 2001), which raises concerns about the total sedative load in older people (Linjakumpu et al., 2003).”
BackgroundInfluentialBenzodiazepine prescribing in elderly Australian general practice patients
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“benzodiazepine prescribing in the elderly.(3-6,8,9) The observed trend of increasing prevalence with age is consistent with several other studies,(9,11) although not all reported this trend.”
ResultTorres-Bondia, F., de Batlle, J., Galván, L., Buti, M., Barbé, F., & Piñol-Ripoll, G. (2020) · BMC Public Health · doi:10.1186/s12889-020-08984-z · Cited by 69 · see citing works
Use of sedative-hypnotics and the risk of Alzheimer’s dementia: A retrospective cohort study
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Why are benzodiazepines not yet controlled substances?
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“They can cause muscle weakness, loss of coordination and gait problems, dizziness, confusion, speech problems, and even anterograde amnesia [15].”
BackgroundCharacteristics associated with benzodiazepine usage in elderly outpatients in Taiwan
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“…depressive symptoms, previous psychiatric disease, previous use of benzodiazepines, concomitant antidepressant use, multiple drug use, and multiple chronic diseases) (MayerOakes et al., 1993; Gleason et al., 1998; Taylor et al., 1998; Blazer et al., 2000; Fourrier et al., 2001; Gray et al., 2003).”
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Benzodiazepine Use among Older Adults with Chronic Obstructive Pulmonary Disease
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“Similar to the general older adult population [13, 15, 17, 19–21], patient characteristics positively associated with Table 3 Characteristics of incident benzodiazepine use among older adults with chronic obstructive pulmonary disease (COPD) between 2004 and 2009, distinguished by COPD severity”
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“This is worrying because BZDRs are commonly used among old persons[1-5], and despite recommendations[7], the use is often longterm[8].”
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“BZDs are widely used among older community-dwelling people, with estimated prevalence varying from 10 to 32 % [2–5].”
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“(14-17), though similar to the rate of 31.9% reported by Fourrier et al. (in France) (18). according to the international narcotics control Board (incB), Belgium is one of the leading consumers of benzodiazepines worldwide (19). it is well documented that continued use of benzodiazepines may lead…”
InfluentialGender differences in the use of anxiolytics and antidepressants: a population based study
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Estimated magnitude of diversion and abuse of opioids relative to benzodiazepines in France
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Utilization of hypnotic medication in the context of cancer: predictors and frequency of use
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“increased risk of consuming hypnotics in the general population, including widowhood [22], being divorced [23], being unemployed [24] or retired [25], a lower level”
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Benzodiazepine use in the elderly: an indicator for inappropriately treated geriatric depression?
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“Female gender, reclusiveness and poor physical health are among the most commonly reported risk factors for the use of benzodiazepines in the elderly (Barnas et al., 1993; Fourrier et al., 2001).”
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“In fact, a number of studies have detected that female gender has minor influence on duration of psychotropic drug use among prevalent users [17, 20, 24], supporting the findings of our study.”
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Anthierens, S., Habraken, H., Petrović, M., Deveugele, M. I., Maeseneer, J. D., & Christiaens, T. (2007) · Europe PMC (PubMed Central) · Cited by 37 · see citing works
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“…of benzodiazepines in the home-dwelling elderly, including non-benzodiazepine drugs acting on the benzodiazepine receptors, such as zolpidem or zopiclone, is most common in France, where one-third of subjects aged 65 years or more were reported to be taking benzodiazepines (Fourrier et al., 2001).”
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“–41 This higher prevalence of use for women can be partly explained by the association of poor sleep and insomnia with menopause.”
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“It should be pointed out that medical drugs such as benzodiazepines, which are widely used (Fourrier et al., 2001), pose the risk of dependence that is necessarily entailed in uninterrupted consumption, as well as additional risk factors, such as their influence on cognitive deterioration in…”
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“Although much information exists on the consumption of BZDs in older adults (Fourrier et al. 2001; Tu et al. 2001; Mah and Upshur 2002; Curran et al. 2003), to our knowledge, no data are currently available on the association between consumption of BDZs and the presence of psychiatric disease in…”
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“Another Canadian study found that being a woman, increasing age, being single and a low education were associated with use of sleep medications and a French study found an association with women, use of other drugs and psychiatric diagnosis.(13,15) The association between long-term use of Z-drugs and use of other drug…”
BackgroundLes problèmes posés par l’utilisation des benzodiazépines chez le patient âgé
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“reported that a poor baseline health was a determinant of a 5-year subsequent use [31].”
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“Age, disability, and mental and somatic illnesses appear to be the strongest determinants of chronic benzodiazepine use [67-69].”
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“9% in the USA [20], 16% in Australia [17], 24% in Canada [21], 25% in Sweden [22], 31% in France [7], 43% in Taiwan [23] and up to 57% in Portugal [24].”
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“Community-dwelling older individuals frequently use benzodiazepines and related drugs (BZDRs), previous studies reporting a point prevalence up to 31% (Fourrier et al., 2001; Linjakumpu et al., 2002; Carrasco-Garrido et al., 2007).”
BackgroundSustained Benzodiazepine Use in a Community Sample of Older Adults
Stowell, K. R., Chang, C. H., Bilt, J. V., Stoehr, G. P., & Ganguli, M. (2008) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2008.02011.x · Cited by 26 · see citing works
“taking two or more other prescription medications, reflecting greater medical (including psychiatric) burden and greater risk for anxiety disorders.20,21 Those taking more medications are also at greater risk of drug–drug interactions (e.g., additive side effects of medications, such as sedation and confusion) and for…”
BackgroundResultInfluentialSedative Load among Community-Dwelling People Aged 75 Years and Older
Taipale, H. T., Bell, J. S., Uusi-Kokko, M., Lönnroos, E., Sulkava, R. O., & Hartikainen, S. A. (2011) · Drugs & Aging · doi:10.2165/11597800-000000000-00000 · Cited by 27 · see citing works
“This finding was similar to that of previous studies investigating the relationship between poor selfrated health and sedative drug use.([1,12,30,32,34,35,37]) The relationship may be multidimensional; poor perceptions of health may negatively impact mental health, leading older people to seek help for psychological s…”
MethodResultFatores associados ao uso de psicotrópicos por idosos residentes no Município de São Paulo
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Benzodiazepine use in Denmark 1997–2008
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“Odds ratios describe the association compared to the reference group with several common diseases in the elderly including cardiovascular disease, chronic obstructive pulmonary disease and depression and thus confirm findings in previous less extensive studies [9,10].”
ResultThe effects of medication assessment on psychotropic drug use in the community-dwelling elderly
Rikala, M., Korhonen, M. J., Sulkava, R. O., & Hartikainen, S. A. (2010) · International Psychogeriatrics · doi:10.1017/s1041610210001547 · Cited by 23 · see citing works
“For instance, use of long-acting benzodiazepines (Hartikainen et al., 2003; Johnell and Fastbom, 2009) and long-term use of benzodiazepines (Jorm et al., 2000; Fourrier et al., 2001) is prevalent in the community-dwelling elderly.”
BackgroundInfluentialAnalysis of benzodiazepine withdrawal program managed by primary care nurses in Spain
Lopez-Peig, C., Mundet, X., Casabella, B., del Val, J. D., Lacasta, D., & Diògene, E. (2012) · BMC Research Notes · doi:10.1186/1756-0500-5-684 · Cited by 28 · see citing works
“This highlights non-compliance with national guidelines based on previous studies [26] which advise limiting the use of BZD to the onset of SSRI treatment.”
MethodPétein, C., Spinewine, A., & Henrard, S. (2021) · Therapeutic Advances in Psychopharmacology · doi:10.1177/20451253211011874 · Cited by 25 · see citing works
The use of benzodiazepines in the aged patient: clinical and pharmacological considerations.
Dailly, É., & Bourin, M. (2008) · PubMed · Cited by 24 · see citing works
Long-term sedative use among community-dwelling adults: a population-based analysis
Weymann, D., Gladstone, E. J., Smolina, K., & Morgan, S. G. (2017) · CMAJ Open · doi:10.9778/cmajo.20160056 · Cited by 23 · see citing works
Sleep medication use in Canadian seniors.
Neutel, C. I., & Patten, S. B. (2009) · PubMed · Cited by 23 · see citing works
Manthey, L., Giltay, E. J., van Veen, T., Neven, A. K., Zitman, F. G., & Penninx, B. W. J. H. (2011) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0b013e3182362484 · Cited by 21 · see citing works
Kuopio 75+ study: does advanced age predict more common use of psychotropics among the elderly?
Hartikainen, S. A., Rahkonen, T., Kautiainen, H., et al. (2003) · International Clinical Psychopharmacology · doi:10.1097/00004850-200305000-00007 · Cited by 22 · see citing works
What's loneliness got to do with it? Older women who use benzodiazepines
Canham, S. L. (2014) · Australian Journal on Ageing · doi:10.1111/ajag.12133 · Cited by 19 · see citing works
Incidence and Characteristics of Benzodiazepine Use in an Elderly Cohort: The EVA Study
Lechevallier‐Michel, N., Berr, C., & Fourrier‐Réglat, A. (2005) · Therapies · doi:10.2515/therapie:2005078 · Cited by 18 · see citing works
Trends in utilization of benzodiazepine and Z‐drugs in Israel
Berman, E., Eyal, S., & Marom, E. (2017) · Pharmacoepidemiology and Drug Safety · doi:10.1002/pds.4338 · Cited by 18 · see citing works
“Benzodiazepines are often the primary treatment choice for general anxiety disorder.(37,38) Although our data did not allow identifying the BZDs by age, studies from other countries indicate that, similar to hypnotic BZDs, anxiolytic BZD are especially prescribed for geriatric patients.”
BackgroundCompliance of psychotropic drug prescription with clinical practice guidelines in older inpatients
Etchepare, F., Pambrun, É., Bégaud, B., Verdoux, H., & Tournier, M. (2015) · Fundamental and Clinical Pharmacology · doi:10.1111/fcp.12167 · Cited by 16 · see citing works
Self-citationSoudry‐Faure, A., Dufouil, C., Ritchie, K. A., Dartigues, J., Tzourio, C., & Alpérovitch, A. (2007) · European Journal of Clinical Pharmacology · doi:10.1007/s00228-007-0392-3 · Cited by 16 · see citing works
“Most previous longitudinal studies considered psychotropic drugs as a whole [8] or focused on benzodiazepines [9].”
BackgroundSelf-citationSedative–hypnotic drug use among community-dwelling elderly in Taiwan
Tseng, H., Yu, S.-H., Lee, C., Huang, W., Huang, S.-L., Wu, C., Chiu, Y., & Hsiung, C. A. (2018) · International Psychogeriatrics · doi:10.1017/s1041610217002940 · Cited by 15 · see citing works
“Additionally, use of sedatives and hypnotics is associated with age, female gender, white race, high school educations, low-to-normal body mass indices (BMIs), and symptoms such as insomnia, anxiety, depression, mental disease, cardiovascular disease (CVD), cancer, multiple chronic diseases, or arthritis, and former u…”
BackgroundIqbal, S. P., Ahmer, S., Farooq, S., Parpio, Y. N., Tharani, A. J., Khan, R. A., & Zaman, M. (2011) · Substance Abuse Treatment Prevention and Policy · doi:10.1186/1747-597x-6-19 · Cited by 15 · see citing works
“9% in France [21-23].”
D’Incau, P., Barbui, C., Tubini, J., & Conforti, A. (2011) · Gender Medicine · doi:10.1016/j.genm.2011.03.003 · Cited by 14 · see citing works
Uso de benzodiazepinas en adultos mayores en América Latina
Gómez, S., León, T., Macuer, M., Alves, M., & Ruíz, S. (2017) · Revista médica de Chile · doi:10.4067/s0034-98872017000300009 · Cited by 14 · see citing works
Factors in duration of anxiolytic, sedative, and hypnotic drug use in the elderly.
Voyer, P., McCubbin, M., Préville, M., & Boyer, R. (2003) · PubMed · Cited by 14 · see citing works
Ten-year trend in sleeping pills use in Switzerland: the CoLaus study
Abolhassani, N., Haba‐Rubio, J., Heinzer, R. C., Vollenweider, P., & Marques-Vidal, P. M. (2019) · Sleep Medicine · doi:10.1016/j.sleep.2018.06.022 · Cited by 13 · see citing works
Shilpa, H. S. S., Kumar, N., Maheswari, E., Virupaksha, H., Subeesh, V., Saraswathy, G. R., & Kunnavil, R. (2019) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2019.07.041 · Cited by 13 · see citing works
Socioeconomic Influences on Benzodiazepine Consumption in an Irish Region
Quigley, P., Usher, C., Bennett, K., & Feely, J. (2006) · European Addiction Research · doi:10.1159/000092116 · Cited by 13 · see citing works
Systematic Review of Benzodiazepines for Anxiety Disorders in Late Life
Gupta, A., Bhattacharya, G., Farheen, S. A., Funaro, M. C., Balasubramaniam, M., Young, J. J., Tampi, D. J., & Tampi, R. R. (2020) · Annals of Clinical Psychiatry · doi:10.1177/104012372003200214 · Cited by 12 · see citing works
THE USE OF HYPNOSEDATIVE DRUGS IN A UNIVERSITY HOSPITAL SETTING
Warie, H., Petrović, M., Somers, A., Mariman, A., Robays, H., & Pevernagie, D. (2003) · Acta Clinica Belgica · doi:10.1179/acb.2003.58.4.003 · Cited by 12 · see citing works
“Taking into account the widespread use of HSs both at home and in hospital, as well as the inherent risk of prolonged use (9), we undertook a registration procedure in order to assess the dynamics of HSs prescription in a university hospital setting.”
MethodDifferences in Benzodiazepine Receptor Agonist Use in Rural and Urban Older Adults
Mattos, M. K., Sereika, S. M., Naples, J. G., & Albert, S. M. (2016) · Drugs - Real World Outcomes · doi:10.1007/s40801-016-0080-7 · Cited by 11 · see citing works
Panes, A., Verdoux, H., Fourrier‐Réglat, A., Berdaï, D., Pariente, A., & Tournier, M. (2020) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2020.03.006 · Cited by 11 · see citing works
Ilomäki, J., Bell, J. S., Kauhanen, J., & Enlund, H. (2011) · Annals of Pharmacotherapy · doi:10.1345/aph.1q375 · Cited by 10 · see citing works
Co-prescriptions of psychotropic drugs to older patients in a general hospital
Beuscart, J., Ficheur, G., Miqueu, M., Luyckx, M., Périchon, R., Puisieux, F. L., Beuscart, R., Chazard, E., & Ferret, L. (2017) · European Geriatric Medicine · doi:10.1016/j.eurger.2016.11.012 · Cited by 10 · see citing works
Nordfjærn, T. (2013) · Human Psychopharmacology Clinical and Experimental · doi:10.1002/hup.2316 · Cited by 9 · see citing works
Prevalence of psychotropic medication use and associated factors in the elderly
Téllez-Lapeira, J. M., Hidalgo, J. D. L.-T., Soler, N. G., et al. (2016) · The European Journal of Psychiatry · Cited by 9 · see citing works
Buspirone in Alzheimer’s disease
Desai, A. K., & Grossberg, G. T. (2003) · Expert Review of Neurotherapeutics · doi:10.1586/14737175.3.1.19 · Cited by 9 · see citing works
CONSUMO DE BENZODIAZEPINAS NO IDOSO DEPRIMIDO
Gonçalves, A., Ferreira, M. M., Florentim, R., et al. (2017) · Revista Portuguesa de Enfermagem de Saúde Mental · doi:10.19131/rpesm.0176 · Cited by 9 · see citing works
Петрушевска, Т., & Stefanovska, V. V. (2014) · Open Access Macedonian Journal of Medical Sciences · doi:10.3889/oamjms.2015.004 · Cited by 7 · see citing works
“In France, 30% of people aged 65 years and over use of BZD [31].”
BackgroundSujets âgés et benzodiazépines : de la consommation à la dépendance
Guillou-Landréat, M., Grall‐Bronnec, M., Victorri‐Vigneau, C., et al. (2008) · NPG. Neurologie, psychiatrie, gériatrie/NPG · doi:10.1016/j.npg.2008.07.002 · Cited by 7 · see citing works
Inappropriate Use of Psychotropic Drugs in Older Individuals: Implications for Practice
Azermai, M., Bourgeois, J., Somers, A., & Petrović, M. (2013) · Aging Health · doi:10.2217/ahe.13.17 · Cited by 7 · see citing works
“The prevalence of benzodiazepine use in community-dwelling older adults varies between 10 [41] and 30% [42].”
BackgroundChatterjee, D., Iliffe, S., Kharicha, K., et al. (2017) · Primary Health Care Research & Development · doi:10.1017/s1463423617000068 · Cited by 6 · see citing works
“…such as coronary heart disease, hypertension, painrelated joint complaints, smoking, cancer, chronic obstructive pulmonary disease, diabetes and multimorbidity (Dealberto et al., 1997; Gleason et al., 1998; Fourrier et al., 2001; Luijendijk et al., 2008; Cheng et al., 2008; van Eijk et al., 2010).”
BackgroundResultInfluentialVilaça, A. T., Vieira, A., Fernandes, A., et al. (2019) · Geriatrics · doi:10.3390/geriatrics4010027 · Cited by 6 · see citing works
“, women are twice as likely to use BZD compared to men [2].”
BackgroundResultBenzodiazepine use and associated factors in elderly in the city of Dourados, MS, Brazil
Cunha, C. D. D. A., de Souza, M. C. C., Cattanio, G. A. A., Iahnn, S. R., & Lima, R. D. C. (2015) · Jornal Brasileiro de Psiquiatria · doi:10.1590/0047-2085000000080 · Cited by 6 · see citing works
Rivas, J. C., Hernández, M., Erazo, J. M., Martínez, M. J., González, C., Cortés, M. P., Muñoz, J., & Miranda, C. (2025) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000414 · Cited by 5 · see citing works
- Authors
- Fourrier, A., Letenneur, L., Dartigues, J., Moore, N., & Bégaud, B.
- Affiliations
- Université Bordeaux Segalen (FR)
- Inserm (FR)
- Venue
- European Journal of Clinical Pharmacology
- Published
- 2001-06-30
- Volume
- 57
- Issue
- 5
- Pages
- 419-425
- ISSN
- 0031-6970 (ISSN-L)
- 1432-1041
- OpenAlex
- W2031479780
- Cited by
- 158
- References
- 0
- Citations by year
- 2025: 1 · 2024: 2 · 2022: 3 · 2021: 8 · 2020: 3 · 2019: 3 · 2018: 7 · 2017: 12 · 2016: 7 · 2015: 11 · 2014: 11 · 2013: 7 · 2012: 8
- FWCI
- 3.59
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- European Journal of Clinical Pharmacology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- benzodiazepine use, older adults, community-dwelling older adults, psychiatric comorbidity, antidepressant use, depressive symptoms, multimorbidity, health perception, life satisfaction, PAQUID cohort
- MeSH terms
- Aged, Aged, 80 and over, Mental Disorders, Benzodiazepines, Drug Utilization, Female, France, Health Status, Humans, Longitudinal Studies, Male, Personal Satisfaction, Population Surveillance, Regression Analysis, Residence Characteristics, Risk Factors, Sex Factors, Anti-Anxiety Agents, Cohort Studies, Confidence Intervals, Proportional Hazards Models, Odds Ratio
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