The prevalence and prescribing patterns of benzodiazepines and Z-drugs in older nursing home residents in different European countries and Israel: retrospective results from the EU SHELTER study
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BACKGROUND: Benzodiazepines (BZDs) and Z-drugs have high potential for developing frequent adverse drug events in older adults (e.g., psychomotor sedation, drug-related dementia, deliria, drug dependence, etc.). Knowledge of the prevalence and patterns of the use of BZDs/Z-drugs in vulnerable older patients is important in order to prevent and reduce the burden caused by their drug-related complications. Our study focused on international comparisons of the prevalence, country-specific prescribing patterns and risk factors of regular BZD/Z-drug use in nursing home (NH) residents. METHODS: This cross-sectional study retrospectively analysed data of 4156 NH residents, prospectively assessed in the Services and Health in the Elderly in Long TERm care (SHELTER) project conducted from 2009 to 2014. Residents aged 65+ in 57 NHs in 7 European countries and Israel were assessed by the InterRAI Long-Term Care Facilities instrument. Descriptive statistics and multiple logistic regression models were used to describe the country-specific prevalence, patterns and risk factors of BZD/Z-drug use. RESULTS: The mean age of the participants was 83.4 ± 9.4 years, 73% were female and 27.7% used BZDs/Z-drugs. The prevalence of BZD/Z-drug use differed significantly across countries, ranging from 44.1% in Israel to 14.5% in Germany. The most frequently prescribed were zopiclone (17.8%), lorazepam (17.1%) and oxazepam (16.3%). Lorazepam, oxazepam and diazepam were used in most of the countries. Brotizolam, temazepam and zolpidem showed highest prevalence in Israel (99.4% of all regular users of this medication in the sample), the Netherlands (72.6%) and France (50.0%), respectively. Residing in Israel was the most significant factor associated with the use of BZDs/Z-drugs or BZDs only (odds ratio [OR] 6.7; 95% confidence interval [CI] 4.8-9.2 and OR 9.7, 95%CI 6.5-14.5, respectively). The use of Z-drugs only was most significantly associated with residing in France (OR 21.0, 95%CI 9.0-48.9). CONCLUSIONS: Despite global recommendations and warnings, the preference for and extent of use of individual BZDs and Z-drugs in vulnerable NH residents differ significantly across countries. The strong association with country of residence compared to clinical and functional factors denotes that prescribing habits, social, cultural, behavioural, and regulatory factors still play an important role in the current diverse use of these medications.
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Previous research has also shown that country of residence is more important than clinical factors in determining psychotropic use and this also suggests that prescribing habits, social, cultural, behavioural and regulatory factors play an important role.
“Previous research has also shown that country of residence is more important than clinical factors in determining psychotropic use and this also suggests that prescribing habits, social, cultural, behavioural and regulatory factors play an important role [8, 87].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [87]
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- Authors
- Lukačišinová, A., Fialová, D., Peel, N. M., Hubbard, R. E., Brkic, J., Onder, G., Topinková, E., Gindin, J., Shochat, T., Gray, L., & Bernabei, R.
- Affiliations
- Charles University (CZ)
- The University of Queensland (AU)
- Istituto Superiore di Sanità (IT)
- University of Haifa (IL)
- Università Cattolica del Sacro Cuore (IT)
- Corresponding author
- Lukačišinová, Anna
- ORCID
- Venue
- BMC Geriatrics
- Published
- 2021-04-26
- Volume
- 21
- Issue
- 1
- Pages
- 277-277
- ISSN
- 1471-2318 (ISSN-L)
- PMC
- PMC8077828
- OpenAlex
- W3159370898
- Cited by
- 35
- References
- 43
- Citations by year
- 2026: 7 · 2025: 6 · 2024: 13 · 2023: 4 · 2022: 5
- FWCI
- 3.04
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Geriatrics (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Zenodo (CERN European Organization for Nuclear Research) (submittedVersion, cc-by)
- Funders
- European Commission (CZ.02.1.01/0.0/0.0/18_069/0010046, H2020 EU, CZ.02.1.01, 764632, H2020, 965341, 2019–2022)
- Horizon 2020 Framework Programme (2019-2022, 764632, 965341)
- FP7 Health
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- benzodiazepines, Z-drugs, nursing home residents, older adults, prescribing patterns, prevalence, long-term care, zopiclone, lorazepam, oxazepam, risk factors, sedative-hypnotic drugs, adverse drug reactions, Israel, Europe, France, Netherlands, Germany
- MeSH terms
- Aged, Aged, 80 and over, Benzodiazepines, Cross-Sectional Studies, Pharmaceutical Preparations, Europe, Female, France, Germany, Humans, Israel, Male, Netherlands, Nursing Homes, Retrospective Studies, Prevalence
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