RISKY GERIATRIC BENZODIAZEPINE USE--PREDICTORS & TRENDS

申请人摘要 令人信服的临床和流行病学证据表明，老年人 在以下三种特定的情况下， 苯二氮卓类（BZ）使用： 使用长效BZ，使用任何BZ， BZ催眠药剂量过高，长期慢性使用。 而 特定的个别老年患者可能会参与这种潜在的 总体而言，有问题的BZ使用，未观察到任何不良后果 这种药物的使用与增加的和可预防的 福尔斯，髋骨骨折，意识模糊，疲劳，过度镇静。 而 在过去的十年中，医生对BZ滥用的关注有所增加， 在20世纪80年代，人们发现了一些令人鼓舞的趋势， 准确的信息可用于描述当前BZ在老年人中的使用情况 患者 在任何时间段内， 确定与之相关的医生或患者的特征， 苯二氮卓类药物使用问题。 这项研究将利用 项目团队已经开发了几个非常大的数据库， 描述了几百人开的处方 上千名老年受试者参加了医疗补助和药房援助 新泽西州的老年人和残疾人计划， 以及为居民提供补充医疗保险的Medex计划 来自马萨诸塞州。 编辑所有其他临床医疗记录 与患者的药物使用记录相关联， 确定其临床特征。 所有数据都被转换成 无法追踪的编码受试者标识符编号，以保护患者 保密 这项研究将：（a）查明总的趋势， 本研究期间老年人使用苯二氮卓类药物可能存在的问题 1986-1994年;（B）详细描述老年患者的特征 使用长效BZ、慢性夜间催眠BZ;和高BZ;（c） 确定定期开处方的医生的特征 可能存在问题的B方案;（d）进行知识调查， 医生对老年人使用BZ的态度;以及（e）相关 这些医生的实际BZ处方实践数据 调查答复。 总之，这些数据将提供一个重要的新的理解， 有问题的使用，否则有价值的一类药物，在这方面， 弱势患者群体。 调查结果将特别用于 随后的干预试验旨在减少频率和不良反应， 老年人中有问题的BZ处方的后果。

APPLICANT'S ABSTRACT Convincing clinical and epidemiologic evidence demonstrates that the elderly are at increased risk of diverse events following three specific kinds of benzodiazepine (BZ) use.: use of long-acting BZs, use of any BZ in excessively high dosages, and chronic long-term use of BZ hypnotic. While specific individual elderly patients may engage in such potentially problematic BZ use without any observed averse consequence, in the aggregate such medication use is associated with an increased and preventable risk of falls, hip fracture, confusion, fatigue, and excessive sedation. While concern over BZ misuse has increased in the last decade among physicians, and some encouraging trends were identified during the 1980s, very little precise information is available to describe current BZ use in older patients. Even less information is available for any time period to identify the characteristics of physicians or patients that are associated with problematic benzodiazepine use. This study will take advantage of several very large databases already developed by the project team, describing every prescription filled by a population of several hundred thousand elderly subjects enrolled in the Medicaid and Pharmacy Assistance for the Aged and Disabled (PAAD) programs of the state of New Jersey, as well as the Medex program of supplementary Medicare insurance for residents of Massachusetts. Compiled Medicare records of all other clinical encounters have been linked to patients medication use records to help define their clinical characteristics. All data have been transformed into untraceable coded subject identifier numbers to protect patient confidentiality. This study will: (a) identify trends of total and potentially problematic Benzodiazepine use in the elderly for the period 1986-1994; (b) describe in detail the characteristics of elderly patients using long acting BZs, chronic nightly hypnotic BZs; and high BZs; (c) identify the characteristics of physicians who regularly prescribe potentially problematic B regimens; (d) perform a survey of knowledge and attitudes of physicians concerning BZ use in the elderly; and (e) related data on the actual BZ prescribing practices of these physicians to their survey responses. Taken together, these data will provide an important new understand of the problematic use of an otherwise valuable class of medications in this vulnerable patient group. The findings will be of particular use for subsequent intervention trials designed to reduce the frequency and adverse consequence of problematic BZ prescription among the elderly.