Is the use of benzodiazepines associated with incident disability?
Is the use of benzodiazepines associated with incident disability?
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DOI：
10.1046/j.1532-5415.2002.50254.x
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发表时间：
2002-06-01
影响因子：
6.3
通讯作者：
Buchner, D
中科院分区：
文献类型：
--
作者：
Gray, SL;LaCroix, AZ;Buchner, D
目的：本研究探讨了苯二氮卓类药物的使用与意外残疾之间的关系，重点是阐明导致苯二氮卓类药物使用的潜在健康状况是否设计：随访4 - 5年的队列研究。地点：华盛顿西部的一个健康维护组织（HMO）。参与者：65岁及以上的个人从随机抽样的I-MO登记谁参加了健康促进干预trial.MEASUREMENTS（n = 1，519）：苯二氮卓类药物的使用被确定从计算机药房记录。自我报告的功能状态进行了评估，使用六项身体功能量表，从剧烈活动的日常生活（ADL）的自我护理活动。两个结果进行了检查：整体身体功能下降和自我护理ADL的限制。多变量模型进行了检查，包括人口统计学特征，健康状况和健康行为，可能是混杂因素。进行了几项分析，以检查是否苯二氮卓类药物的使用或混杂因素是负责functionaldecline.RESULTS：苯二氮卓类药物的使用是显着相关的事件损失的身体功能（风险比（HR）= 1.51，95%的置信区间（Cl）= 1.02-2.24）在充分调整的模型。虽然苯二氮卓类药物的使用与ADL限制相关，但在调整其他因素时并不显著（HR = 1.71，95% CI = 0.87-3.34）。我们的一些研究结果表明，导致苯二氮卓类药物使用的健康状况可能部分或完全解释这些关联：（1）使用抗焦虑苯二氮卓类药物（HR = 1.95，95% CI = 1.24-3.07），但不是催眠药（HR = 1，21，95%CI = 0.73-2.00），与功能下降相关;（2）调整健康状况变量使这些相关性最小化;（3）几乎没有剂量反应的证据。身体功能下降的风险适度增加与苯二氮卓类药物的使用相关，尤其是抗焦虑药。导致苯二氮卓类药物使用的健康状况在残疾发病机制中可能比苯二氮卓类药物使用本身更重要。尽管有许多原因可以避免老年人使用苯二氮卓类药物，但仍不清楚使用苯二氮卓类药物是否会独立导致功能下降。
OBJECTIVES: This study examined the association between benzodiazepine use and incident disability with an emphasis on elucidating whether the underlying health conditions that result in benzodiazepine use (confounding factors) or intrinsic adverse effects of benzodiazepine use were responsible for functional decline.DESIGN: Cohort study with follow-up of 4 to 5 years.SETTING: A health maintenance organization (HMO) in western Washington.PARTICIPANTS: Individuals aged 65 and older from a random sample of I-MO enrollees who participated in a health promotion intervention trial (n = 1,519).MEASUREMENTS: Benzodiazepine use was ascertained from computerized pharmacy records. Self-reported functional status was assessed using a six-item physical function scale ranging from vigorous activity to self-care activities of daily living (ADLs). Two outcomes were examined: decline in overall physical function and limitations in self-care ADLs. Multivariate models were examined that included demographic characteristics, health status, and health behaviors that were likely to be confounders. Several analyses were conducted to examine whether benzodiazepine use or confounding factors were responsible for functional decline.RESULTS: Benzodiazepine use was significantly associated with incident loss of physical function (hazard ratio (HR) = 1.51, 95% confidence interval (Cl) = 1.02-2.24) in the fully adjusted model. Although use of benzodiazepines was associated with limitations in ADLs, it was not significant when adjusting for other factors (HR = 1.71, 95% CI = 0.87-3.34). Several of our findings suggest that the health conditions leading to benzodiazepine use may partly or fully explain these associations: (1) use of anxiolytic benzodiazepines (HR = 1.95, 95% CI = 1.24-3.07), but not hypnotic agents (HR = 1,21, 95% Cl = 0.73-2.00), was associated with functional decline; (2) adjustment for health status variables minimized these associations; and (3) there was little evidence of dose response.CONCLUSIONS: A modestly increased risk for decline in physical function was associated with benzodiazepine use, especially of anxiolytic agents. The health conditions that result in benzodiazepine use may be more important in the pathogenesis of disability than benzodiazepine use itself. Although there are man), reasons for avoiding benzodiazepines in older adults, it is Still unclear whether use contributes independently to functional decline.