Trajectories Associated With the Use and Deprescription of Benzodiazepines and‐Drugs in a Network of Geriatric Outpatient Clinics

Abstract

ABSTRACT Purpose To determine the trajectories of benzodiazepine (BZD) and Z‐drug use among older adults (= 3590) followed in a network of geriatric outpatient clinics in Brazil. pds70419-sec-0001 Methods This longitudinal study evaluated BZD and Z‐drug use over a 24‐month follow‐up period. The proportion of use at baseline and at the end of the study period was compared using the McNemar test. Two trajectories were considered:and. Comparisons between trajectories and independent variables were performed using Pearson's chi‐square test. Variables with< 0.20 were eligible for multivariate analysis. Multivariate models were also used to identify factors associated with BZD or Z‐drug use at baseline and with trajectories of initiation and discontinuation. Odds ratios (OR) with 95% confidence intervals were estimated. pds70419-sec-0002 Results A small but significant reduction in overall BZD or Z‐drug use was observed (17.4% to 16.0%;= 0.007), with a marked decrease in isolated Z‐drug use (6.1% to 4.0%;< 0.001). At baseline, use was associated with female sex (OR = 1.48; 95% CI 1.19–1.84), age 60–74 years (OR = 1.64; 95% CI 1.29–2.10), having ≥ 2 fall‐related conditions (OR = 2.53; 95% CI 1.94–3.31), higher frailty scores, and cognitive dysfunction (OR = 1.32; 95% CI 1.00–1.74). Initiation was associated with pharmacist consultations during follow‐up (OR = 5.01; 95% CI 2.88–8.71), depression (OR = 2.59; 95% CI 1.80–3.73), insomnia (OR = 1.97; 95% CI 1.19–3.25), and panic syndrome. Pharmacist consultation was also associated with discontinuation (OR = 0.34; 95% CI 0.15–0.76). pds70419-sec-0003 Conclusions Clinical vulnerability and psychiatric conditions were associated with BZD or Z‐drug use and initiation, while pharmacist consultations were associated with both initiation and discontinuation trajectories. pds70419-sec-0004 Key Points There was a reduction in the use of Benzodiazepines or Z‐drugs and a significant reduction in the isolated use of Z‐drugs among the older adults followed in this study. pds70419-li-0001 Female sex, younger age among older adults (60–74 years), higher frailty, cognitive dysfunction, and the presence of multiple fall‐related conditions were associated with the use of benzodiazepines or Z‐drugs at baseline. pds70419-li-0002 Depression, insomnia, and panic disorder were positively associated with the trajectory of initiation of benzodiazepine or Z‐drug use among older adults. pds70419-li-0003 Pharmacist consultations during follow‐up were associated with both initiation and discontinuation trajectories of benzodiazepine or Z‐drug use. pds70419-li-0004 The association between pharmacist consultations and medication use trajectories likely reflects greater healthcare utilization among clinically complex patients, highlighting the importance of careful interpretation of observational findings. pds70419-li-0005 bullet pds70419-list-0001 highlights pds70419-abs-5002 Plain Language Summary Benzodiazepines and Z‐drugs are commonly used to treat anxiety and sleep problems, but their use in older adults is associated with risks such as falls, cognitive impairment, and dependence. Understanding how the use of these medications changes over time can help to improve the care of older patients. This study followed 3590 older adults treated in a network of geriatric outpatient clinics in Brazil for 24 months. We analyzed two patterns of medication use: individuals whobenzodiazepines or Z‐drugs and those who stopped using them during the follow‐up. We also examined clinical and care‐related factors associated with these changes. Overall, the use of these medications decreased slightly during the study period, with a more pronounced reduction in Z‐drug use. At the beginning of the study, the use was more common among women, aged 60–74 years, with two or more conditions related to falls, higher frailty scores, and cognitive dysfunction. Starting use during follow‐up was associated with depression, insomnia, panic syndrome, and pharmacist consultations. Pharmacist consultations were also associated with stopping these medications, suggesting that contact with healthcare professionals may influence medication use among older adults. plain-language-summary pds70419-abs-5003