RISKY GERIATRIC BENZODIAZEPINE USE--PREDICTORS & TRENDS

申请人的抽象

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.