Abstract
Objective
To study temporal trends of benzodiazepine exposure among incident Alzheimer's disease
and related dementia (ADRD) cohorts between 2011 and 2016.
Design
Repeated cross-sectional study.
Setting and Participants
Three nationwide incident ADRD cohorts (community-dwelling and institutionalized subjects)
were identified in 2011, 2013, and 2016 through the French health insurance database.
Subjects were followed 4 semesters around ADRD identification [Semester −2 (S−2) to Semester 2 (S2)].
Measures
Odds ratios (ORs) for semestrial prevalent exposure, initiation, and adherence to
benzodiazepine prescription recommendations (prescription duration <3 months, single
reimbursement) were computed using multivariate logistic regressions for each cohort
and according to benzodiazepine half-life.
Results
Among 262,024 community-dwelling subjects, as compared to 2011, overall benzodiazepine
prevalence risk decreased slightly immediately after ADRD identification [S1: aOR2013 = 0.93 (0.91-0.95), aOR2016 = 0.95 (0.93-0.97)] and did not differ during S2. Among 72,013 institutionalized subjects, it increased over time [S2: aOR2013 = 1.16 (1.11-1.21), aOR2016 = 1.26 (1.21-1.32)]. Long half-life benzodiazepine prevalence risk decreased in the
4 semesters among recent cohorts, for both populations [S2: community-dwelling: aOR2013 = 0.77 (0.74-0.79), aOR2016 = 0.61 (0.59-0.64); institutionalized: aOR2013 = 0.74 (0.68-0.80), aOR2016 = 0.58 (0.54-0.63)]. Short half-life benzodiazepine prevalence risk increased [S2: community-dwelling: aOR2013 = 1.13 (1.10-1.16), aOR2016 = 1.22 (1.20-1.25); institutionalized: aOR2013 = 1.26 (1.21-1.32), aOR2016 = 1.44 (1.38-1.50)]. The same patterns were observed for benzodiazepine initiation.
Adherence to benzodiazepine prescription recommendations (based on French prescription
duration) worsened over years [prescription duration <3 months: aOR2013 = 0.90 (0.86-0.95), aOR2016 = 0.90 (0.85-0.95), single reimbursement: aOR2013 = 0.95 (0.91-1.00), aOR2016 = 0.94 (0.90-0.99)].
Conclusions and Implications
Long half-life benzodiazepine exposure was reduced whereas short half-life benzodiazepine
exposure increased, and adherence to recommendations worsened (prescription duration
longer than 3 months and more than a single reimbursement in recent cohorts). Efforts
from prescribers and authorities are required in order to restrict psychotropic exposure
among the ADRD population. Further research among institutionalized ADRD subjects
could provide useful data to disentangle the effects of changes in prescribing practices
and in patients' characteristics.
Keywords
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References
- Dementia.(Available at:)
- Alzheimer's disease: Expedition into the unknown.Lancet. 2016; 388: 2713
- Diagnostic and Statistical Manual of Mental Disorders.5th ed. American Psychiatric Association, Washington, DC2013
- Alzheimer disease: Non-pharmacological and pharmacological management of cognition and neuropsychiatric symptoms.Australas Psychiatry. 2018; 26: 358-365
- Maladie d'Alzheimer et Maladies Apparentées: Prise En Charge Des Troubles Du Comportement Perturbateurs [Alzheimer's Disease and Related Dementias: Management of Behavioural and Psychological Symptoms of Dementia].2009
- American Geriatrics Society 2019 Updated AGS Beers Criteria® for potentially inappropriate medication Use in older adults.J Am Geriatr Soc. 2019; 67: 674-694
- STOPP/START criteria for potentially inappropriate prescribing in older people: Version 2.Age Ageing. 2015; 44: 213-218
- Potentially inappropriate medications in the elderly: A French consensus panel list.Eur J Clin Pharmacol. 2007; 63: 725-731
- Benzodiazépine à Demi Vie Longue Chez Le Sujet Âgé [Long Half Life Benzodiazepine in the Elderly].2012
- Benzodiazepine, psychotropic medication, and dementia: A population-based cohort study.Alzheimers Dement. 2016; 12: 604-613
- Etat des lieux de la consommation des benzodiazépines en France [Overview of benzodiazepine use in France].2017
- Trends in incident use of benzodiazepines and Z-drugs in France from 2006 to 2012: A population-based study.Pharmacoepidemiol Drug Saf. 2017; 26: 162-169
- Trends in use of psychotropic medications among patients treated with cholinesterase inhibitors in Japan from 2002 to 2010.Int Psychogeriatr. 2015; 27: 407-415
- Pharmaceutical consumption and cost in patients with dementia: A longitudinal study by the Registry of Dementias of Girona (ReDeGi) in Catalonia (Spain).Arch Gerontol Geriatr. 2015; 60: 448-452
- Changing pattern of sedative use in older adults: A population-based cohort study.Drugs Aging. 2016; 33: 523-533
- Benzodiazepine use and risk of dementia: Prospective population based study.BMJ. 2012; 345: e6231
- Benzodiazepine use and risk of Alzheimer's disease: Case-control study.BMJ. 2014; 349: g5205
- The benzodiazepine-dementia disorders link: Current state of knowledge.CNS Drugs. 2016; 30: 1-7
- Arrêt Des Benzodiazépines et Médicaments Apparentés: Démarche Du Médecin Traitant En Ambulatoire [Benzodiazepines and related drugs discontinuation: procedure of the primary care physician].2015
- Value of a national administrative database to guide public decisions: From the système national d'information interrégimes de l'Assurance Maladie (SNIIRAM) to the système national des données de santé (SNDS) in France.Rev Epidemiol Sante Publique. 2017; 65: S149-S167
- The National Healthcare System claims databases in France, SNIIRAM and EGB: Powerful tools for pharmacoepidemiology.Pharmacoepidemiol Drug Saf. 2017; 26: 954-962
- French health insurance databases: What interest for medical research?.Rev Med Interne. 2015; 36: 411-417
- Rev Epidemiol Sante Publique. 2017; 65: S183-S197
- Overview of drug data within French health insurance databases and implications for pharmacoepidemiological studies.Fundam Clin Pharmacol. 2016; 30: 616-624
- ATC/DDD index.(Available at:)
- Mémo choix d'une benzodiazépine [Choice of a Benzodiazepine].(Available at:) (Accessed April 30, 2019)
- Immeasurable time bias due to hospitalization in medico-administrative databases: Which impact for pharmacoepidemiological studies?.Pharmacoepidemiol Drug Saf. 2017; 26: 544-553
- Ecological association between a deprivation index and mortality in France over the period 1997-2001: Variations with spatial scale, degree of urbanicity, age, gender and cause of death.BMC Public Health. 2009; 9: 33
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation.J Chronic Dis. 1987; 40: 373-383
- Trends in the prevalence of antipsychotic drug use among patients with Alzheimer's disease and other dementias including those treated with antidementia drugs in the community in the UK: A cohort study.BMJ Open. 2013; 3 (e002080)
- Misuse of benzodiazepines in France.Neuropathology of Drug Addictions and Substance Misuse. 2. Academic Press, San Diego2016 (p. 1101-1111)
- La Situation Des EHPAD En 2016 [Nursing Homes' situation in 2016].2017
- La Situation Des EHPAD En 2017 [Nursing Homes' situation in 2017].2019
- High prevalence of psychotropic drug use among persons with and without Alzheimer's disease in Finnish nationwide cohort.Eur Neuropsychopharmacol. 2014; 24: 1729-1737
- Impact of FDA black box warning on psychotropic drug use in noninstitutionalized elderly patients diagnosed with dementia: A retrospective study.J Pharm Pract. 2016; 29: 495-502
- Improvements in the prescribing of antipsychotics in dementia and psychogeriatric units in New Zealand.Int J Clin Pharm. 2016; 38: 941-949
- Change in psychotropic drug use in Norwegian nursing homes between 2004 and 2011.Int Psychogeriatr. 2018; 30: 385-394
- Psychotropic drug use among people with dementia—a six-month follow-up study.BMC Pharmacol Toxicol. 2013; 14: 56
- Regional changes in psychotropic use among Finnish persons with newly diagnosed Alzheimer's disease in 2005-2011.PLoS One. 2017; 12: e0173450
Article info
Publication history
Published online: April 13, 2020
Footnotes
The authors declare no conflicts of interest.
Identification
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© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
