TY - JOUR
T1 - Benzodiazepine Receptor Agonists Use and Cessation Among Multimorbid Older Adults with Polypharmacy
T2 - Secondary Analysis from the OPERAM Trial
AU - Sibille, François-Xavier
AU - de Saint-Hubert, Marie
AU - Henrard, Séverine
AU - Aubert, Carole Elodie
AU - Goto, Namiko Anna
AU - Jennings, Emma
AU - Dalleur, Olivia
AU - Rodondi, Nicolas
AU - Knol, Wilma
AU - O'Mahony, Denis
AU - Schwenkglenks, Matthias
AU - Spinewine, Anne
N1 - Funding Information:
The first author would like to thank Alain Guillet (Support en méthodologie et calculs statistiques, Université Catholique de Louvain) for his support in the data management and statistical analysis. We thank all participants of the OPERAM trial that provided the data for this secondary analysis.
Funding Information:
This work is part of the project “OPERAM: OPtimising thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly” supported by the European Union's Horizon 2020 research and innovation program under the grant agreement No. 634238, and by the Swiss State Secretariat for Education, Research and Innovation (SERI) under contract number 15.0137. The OPERAM project was also partially funded by the Swiss National Scientific Foundation (SNSF 320030_188549 and 325130_204361). François-Xavier Sibille is a Clinical Master Specialist Applicant for a Ph.D. of the Fonds de la Recherche Scientifique—FNRS. The opinions expressed herein are those of the authors and do not necessarily reflect the official views of the funders. The funders had no role in the study design; data collection, analysis, and interpretation; or writing of the report. Open access funding was provided by UCLouvain and CHU UCL Namur.
Publisher Copyright:
© 2023, The Author(s).
PY - 2023/6
Y1 - 2023/6
N2 - BACKGROUND: Benzodiazepine receptor agonists (BZRAs) are commonly prescribed in older adults despite an unfavorable risk-benefit ratio. Hospitalizations may provide a unique opportunity to initiate BZRA cessation, yet little is known about cessation during and after hospitalization. We aimed to measure the prevalence of BZRA use before hospitalization and the rate of cessation 6 months later, and to identify factors associated with these outcomes.METHODS: We conducted a secondary analysis of a cluster randomized controlled trial (OPtimising thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly [OPERAM]), comparing usual care and in-hospital pharmacotherapy optimization in adults aged 70 years or over with multimorbidity and polypharmacy in four European countries. BZRA cessation was defined as taking one or more BZRA before hospitalization and not taking any BZRA at the 6-month follow-up. Multivariable logistic regression was performed to identify factors associated with BZRA use before hospitalization and with cessation at 6 months.RESULTS: Among 1601 participants with complete 6-month follow-up data, 378 (23.6%) were BZRA users before hospitalization. Female sex (odds ratio [OR] 1.52 [95% confidence interval 1.18-1.96]), a higher reported level of depression/anxiety (OR up to 2.45 [1.54-3.89]), a higher number of daily drugs (OR 1.08 [1.05-1.12]), use of an antidepressant (OR 1.74 [1.31-2.31]) or an antiepileptic (OR 1.46 [1.02-2.07]), and trial site were associated with BZRA use. Diabetes mellitus (OR 0.60 [0.44-0.80]) was associated with a lower probability of BZRA use. BZRA cessation occurred in 86 BZRA users (22.8%). Antidepressant use (OR 1.74 [1.06-2.86]) and a history of falling in the previous 12 months (OR 1.75 [1.10-2.78]) were associated with higher BZRA cessation, and chronic obstructive pulmonary disease (COPD) (OR 0.45 [0.20-0.91]) with lower BZRA cessation.CONCLUSION: BZRA prevalence was high among included multimorbid older adults, and BZRA cessation occurred in almost a quarter of them within 6 months after hospitalization. Targeted BZRA deprescribing programs could further enhance cessation. Specific attention is needed for females, central nervous system-acting co-medication, and COPD co-morbidity.REGISTRATION: ClinicalTrials.gov identifier: NCT02986425. December 8, 2016.
AB - BACKGROUND: Benzodiazepine receptor agonists (BZRAs) are commonly prescribed in older adults despite an unfavorable risk-benefit ratio. Hospitalizations may provide a unique opportunity to initiate BZRA cessation, yet little is known about cessation during and after hospitalization. We aimed to measure the prevalence of BZRA use before hospitalization and the rate of cessation 6 months later, and to identify factors associated with these outcomes.METHODS: We conducted a secondary analysis of a cluster randomized controlled trial (OPtimising thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly [OPERAM]), comparing usual care and in-hospital pharmacotherapy optimization in adults aged 70 years or over with multimorbidity and polypharmacy in four European countries. BZRA cessation was defined as taking one or more BZRA before hospitalization and not taking any BZRA at the 6-month follow-up. Multivariable logistic regression was performed to identify factors associated with BZRA use before hospitalization and with cessation at 6 months.RESULTS: Among 1601 participants with complete 6-month follow-up data, 378 (23.6%) were BZRA users before hospitalization. Female sex (odds ratio [OR] 1.52 [95% confidence interval 1.18-1.96]), a higher reported level of depression/anxiety (OR up to 2.45 [1.54-3.89]), a higher number of daily drugs (OR 1.08 [1.05-1.12]), use of an antidepressant (OR 1.74 [1.31-2.31]) or an antiepileptic (OR 1.46 [1.02-2.07]), and trial site were associated with BZRA use. Diabetes mellitus (OR 0.60 [0.44-0.80]) was associated with a lower probability of BZRA use. BZRA cessation occurred in 86 BZRA users (22.8%). Antidepressant use (OR 1.74 [1.06-2.86]) and a history of falling in the previous 12 months (OR 1.75 [1.10-2.78]) were associated with higher BZRA cessation, and chronic obstructive pulmonary disease (COPD) (OR 0.45 [0.20-0.91]) with lower BZRA cessation.CONCLUSION: BZRA prevalence was high among included multimorbid older adults, and BZRA cessation occurred in almost a quarter of them within 6 months after hospitalization. Targeted BZRA deprescribing programs could further enhance cessation. Specific attention is needed for females, central nervous system-acting co-medication, and COPD co-morbidity.REGISTRATION: ClinicalTrials.gov identifier: NCT02986425. December 8, 2016.
UR - http://www.scopus.com/inward/record.url?scp=85160247103&partnerID=8YFLogxK
U2 - 10.1007/s40266-023-01029-1
DO - 10.1007/s40266-023-01029-1
M3 - Article
C2 - 37221407
SN - 1170-229X
VL - 40
SP - 551
EP - 561
JO - Drugs & Aging
JF - Drugs & Aging
IS - 6
ER -