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Benzodiazepine Receptor Agonists Use and Cessation Among Multimorbid Older Adults with Polypharmacy: Secondary Analysis from the OPERAM Trial
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 meas...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10232614/ https://www.ncbi.nlm.nih.gov/pubmed/37221407 http://dx.doi.org/10.1007/s40266-023-01029-1 |
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author | Sibille, François-Xavier de Saint-Hubert, Marie Henrard, Séverine Aubert, Carole Elodie Goto, Namiko Anna Jennings, Emma Dalleur, Olivia Rodondi, Nicolas Knol, Wilma O’Mahony, Denis Schwenkglenks, Matthias Spinewine, Anne |
author_facet | Sibille, François-Xavier de Saint-Hubert, Marie Henrard, Séverine Aubert, Carole Elodie Goto, Namiko Anna Jennings, Emma Dalleur, Olivia Rodondi, Nicolas Knol, Wilma O’Mahony, Denis Schwenkglenks, Matthias Spinewine, Anne |
author_sort | Sibille, François-Xavier |
collection | PubMed |
description | 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40266-023-01029-1. |
format | Online Article Text |
id | pubmed-10232614 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-102326142023-06-02 Benzodiazepine Receptor Agonists Use and Cessation Among Multimorbid Older Adults with Polypharmacy: Secondary Analysis from the OPERAM Trial Sibille, François-Xavier de Saint-Hubert, Marie Henrard, Séverine Aubert, Carole Elodie Goto, Namiko Anna Jennings, Emma Dalleur, Olivia Rodondi, Nicolas Knol, Wilma O’Mahony, Denis Schwenkglenks, Matthias Spinewine, Anne Drugs Aging Original Research Article 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40266-023-01029-1. Springer International Publishing 2023-05-23 2023 /pmc/articles/PMC10232614/ /pubmed/37221407 http://dx.doi.org/10.1007/s40266-023-01029-1 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by-nc/4.0/Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Original Research Article Sibille, François-Xavier de Saint-Hubert, Marie Henrard, Séverine Aubert, Carole Elodie Goto, Namiko Anna Jennings, Emma Dalleur, Olivia Rodondi, Nicolas Knol, Wilma O’Mahony, Denis Schwenkglenks, Matthias Spinewine, Anne Benzodiazepine Receptor Agonists Use and Cessation Among Multimorbid Older Adults with Polypharmacy: Secondary Analysis from the OPERAM Trial |
title | Benzodiazepine Receptor Agonists Use and Cessation Among Multimorbid Older Adults with Polypharmacy: Secondary Analysis from the OPERAM Trial |
title_full | Benzodiazepine Receptor Agonists Use and Cessation Among Multimorbid Older Adults with Polypharmacy: Secondary Analysis from the OPERAM Trial |
title_fullStr | Benzodiazepine Receptor Agonists Use and Cessation Among Multimorbid Older Adults with Polypharmacy: Secondary Analysis from the OPERAM Trial |
title_full_unstemmed | Benzodiazepine Receptor Agonists Use and Cessation Among Multimorbid Older Adults with Polypharmacy: Secondary Analysis from the OPERAM Trial |
title_short | Benzodiazepine Receptor Agonists Use and Cessation Among Multimorbid Older Adults with Polypharmacy: Secondary Analysis from the OPERAM Trial |
title_sort | benzodiazepine receptor agonists use and cessation among multimorbid older adults with polypharmacy: secondary analysis from the operam trial |
topic | Original Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10232614/ https://www.ncbi.nlm.nih.gov/pubmed/37221407 http://dx.doi.org/10.1007/s40266-023-01029-1 |
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