Benzodiazepine Use and Deprescribing in Belgian Nursing Homes : Results from the COME-ON Study

© 2020 The American Geriatrics Society..

BACKGROUND/OBJECTIVES: To describe the use and deprescribing of benzodiazepine receptor agonists (BZRAs) among nursing home residents (NHRs), to evaluate appropriateness of use and to identify factors associated with BZRA use and deprescribing.

DESIGN: Posthoc analysis of the Collaborative Approach to Optimize Medication Use for Older People in Nursing Homes (COME-ON) study, a cluster controlled trial that evaluated the impact of a complex intervention on potentially inappropriate prescriptions (PIPs) in nursing homes (NHs).

SETTING: A total of 54 NHs in Belgium.

PARTICIPANTS: A total of 797 NHRs included in the study who had complete medical, clinical, and medication information at baseline and at the end of the study (month 15).

MEASUREMENTS: Data were recorded by participating healthcare professionals. Reasons why BZRA use was considered as PIPs were assessed using the 2019 American Geriatrics Society Beers Criteria® and the Screening Tool of Older Persons' Prescriptions (STOPP) criteria, version 2. Deprescribing included complete cessation or decreased daily dose. We identified factors at the NHR, prescriber, and NH levels associated with BZRA use and BZRA deprescribing using multivariable binary and multinomial logistic regression, respectively.

RESULTS: At baseline, 418 (52.4%) NHRs were taking a BZRA. The use of BZRA for longer than 4 weeks, with two or more other central nervous system active drugs, and in patients with delirium, cognitive impairment, falls, or fractures was found in more than 67% of BZRA users. Eight NHR-related variables and two prescriber-related variables were associated with regular BZRA use. Deprescribing occurred in 28.1% of BZRA users (32.9% in the intervention group and 22.1% in the control group). In addition to four other factors, dementia (odds ratio [OR] = 2.35; 95% confidence interval [CI] = [1.45-3.83]) and intervention group (OR = 1.74; 95% CI = 1.07-2.87) were associated with deprescribing.

CONCLUSION: Use of BZRAs was highly prevalent, and reasons to consider it as PIP were frequent. Deprescribing occurred in one-fourth of NHRs, which is encouraging. Future interventions should focus on specific aspects of PIPs (ie, indication, duration, drug-drug and drug-disease interactions) as well as on nondementia patients.

Medienart:

E-Artikel

Erscheinungsjahr:

2020

Erschienen:

2020

Enthalten in:

Zur Gesamtaufnahme - volume:68

Enthalten in:

Journal of the American Geriatrics Society - 68(2020), 12 vom: 04. Dez., Seite 2768-2777

Sprache:

Englisch

Beteiligte Personen:

Evrard, Perrine [VerfasserIn]
Henrard, Séverine [VerfasserIn]
Foulon, Veerle [VerfasserIn]
Spinewine, Anne [VerfasserIn]

Links:

Volltext

Themen:

12794-10-4
Benzodiazepine
Benzodiazepines
Deprescribing
Inappropriate prescribing
Journal Article
Nursing homes
Older adults
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Anmerkungen:

Date Completed 18.03.2021

Date Revised 18.03.2021

published: Print-Electronic

Citation Status MEDLINE

doi:

10.1111/jgs.16751

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM313607443