Benzodiazepine Use and Physical Disability in Community-Dwelling Older Adults

Department of Psychiatry, VU University Amsterdam, Amsterdamo, North Holland, Netherlands
Journal of the American Geriatrics Society (Impact Factor: 4.57). 02/2006; 54(2):224-30. DOI: 10.1111/j.1532-5415.2005.00571.x
Source: PubMed


To determine whether benzodiazepine use is associated with incident disability in mobility and activities of daily living (ADLs) in older individuals.
A prospective cohort study.
Four sites of the Established Populations for Epidemiologic Studies of the Elderly.
This study included 9,093 subjects (aged > or =65) who were not disabled in mobility or ADLs at baseline.
Mobility disability was defined as inability to walk half a mile or climb one flight of stairs. ADL disability was defined as inability to perform one or more basic ADLs (bathing, eating, dressing, transferring from a bed to a chair, using the toilet, or walking across a small room). Trained interviewers assessed outcomes annually.
At baseline, 5.5% of subjects reported benzodiazepine use. In multivariable models, benzodiazepine users were 1.23 times as likely as nonusers (95% confidence interval (CI) = 1.09-1.39) to develop mobility disability and 1.28 times as likely (95% CI = 1.09-1.52) to develop ADL disability. Risk for incident mobility was increased with short- (hazard ratio (HR) = 1.27, 95% CI = 1.08-1.50) and long-acting benzodiazepines (HR = 1.20, 95% CI = 1.03-1.39) and no use. Risk for ADL disability was greater with short- (HR = 1.58, 95% CI = 1.25-2.01) but not long-acting (HR = 1.11, 95% CI = 0.89-1.39) agents than for no use.
Older adults taking benzodiazepines have a greater risk for incident mobility and ADL disability. Use of short-acting agents does not appear to confer any safety benefits over long-acting agents.

Download full-text


Available from: Shelly L Gray, Aug 11, 2014
  • Source
    • "Our results demonstrate that benzodiazepine exposure is related to greater difficulty with basic ADL over time. This result is consistent with two previous studies which found an association with decline in ADL (Gray et al., 2006; Sarkisian et al., 2000), but inconsistent with two other studies that found no association (Gray et al., 2002; Leveille et al., 1992). The studies that found significant associations had larger sample sizes, longer follow-up periods, and sampled older adults from diverse geographical areas (Gleason et al., 1998; Ried et al., 1998), which indicates these results may be more representative of the general population than the studies reporting no association (Gray et al., 2002; Leveille et al., 1992). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of the study was to determine the prospective association between baseline BZD use and mobility, functioning, and pain among urban and rural African-American and non-Hispanic white community-dwelling older adults. From 1999 to 2001, a cohort of 1000 community-dwelling adults, aged ≥65 years, representing a random sample of Medicare beneficiaries, stratified by ethnicity, sex, and urban/rural residence were recruited. BZD use was assessed at an in-home visit. Every six months thereafter, study outcomes were assessed via telephone for 8.5-years. Mobility was assessed with the Life-Space Assessment (LSA). Functioning was quantified with level of difficulty in five basic activities of daily living (ADL: bathing, dressing, transferring, toileting, eating), and six instrumental activities of daily living (IADL: shopping, managing money, preparing meals, light and heavy housework, telephone use). Pain was measured by frequency per week and the magnitude of interference with daily tasks. All analytic models were adjusted for relevant covariates and mental health symptoms. After multivariable adjustment, baseline BZD use was significantly associated with greater difficulty with basic ADL (Estimate=0.39, 95% confidence interval (CI): 0.04-0.74), and more frequent pain (Estimate=0.41, 95%CI: 0.09-0.74) in the total sample and declines in mobility among rural residents (Estimate=-0.67, t(5,902)=-1.98, p=0.048), over 8.5 years. BZD use was prospectively associated with greater risk for basic ADL difficulties and frequent pain among African-American and non-Hispanic white community-dwelling older adults, and life-space mobility declines among rural-dwellers, independently of relevant covariates. These findings highlight the potential long-term negative impact of BZD use among community-dwelling older adults.
    Archives of Gerontology and Geriatrics 09/2014; 59(2):331-337. DOI:10.1016/j.archger.2014.04.017 · 1.85 Impact Factor
  • Source
    • "Many older people with dementia and neuropsychiatric symptoms can be withdrawn from chronic antipsychotic treatment without deterioration, however, some people could benefit from continuing their antipsychotic medication [11]. Benzodiazepines can cause problems with impaired cognition [12], incident mobility and ADL disability among old people [13]. Benzodiazepines and other hypnotics and sedatives might also worsen sleep apnea syndrome [14] and are therefore contraindicated among people with this condition. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Psychotropic drugs are widely used among old people with dementia but few studies have described long-term treatment in this group of patients. The purpose of this study was to explore the long-term use of psychotropic drugs in old people with dementia. Data on psychotropic drug use, functioning in the activities of daily living (ADL), cognitive function and behavioral and psychological symptoms were collected at baseline and six months later, using the Multi-Dimensional Dementia Assessment Scale (MDDAS). The data were collected in 2005--2006. Detailed data about the prescribing of psychotropic drugs were collected from prescription records. This study was conducted in 40 specialized care units in northern Sweden, with a study population of 278 people with dementia. At the start of the study, 229 of the participants (82%) were prescribed at least one psychotropic drug; 150 (54%) used antidepressants, 43 (16%) used anxiolytics, 107 (38%) used hypnotics and sedatives, and 111 (40%) used antipsychotics. Among the baseline users of antidepressants, anxiolytics, hypnotics and sedatives and antipsychotics, 67%, 44% 57% and 57% respectively, still used the same dose of the same psychotropic drug after six months. Associations were found between behavioral and psychological symptoms and different psychotropic drugs. Psychotropic drug use was high among people with dementia living in specialized care units and in many cases the drugs were used for extended periods. It is very important to monitor the effects and adverse effects of the prescribed drug in this frail group of people.
    BMC pharmacology & toxicology 11/2013; 14(1):56. DOI:10.1186/2050-6511-14-56
  • Source
    • "Anxiety pharmacotherapy also presents challenges. Benzodiazepines are the most frequently prescribed anxiolytic medication in older adults, of which approximately half are long half-life agents (Gray et al., 2006). However, they are associated with a number of adverse risks, especially those with a long half-life, including cognitive impairment, psychomotor impairment, excessive daytime sedation, instability of gait, falls, and hip fractures (Gray et al., 2002; Gray et al., 2006; Ried et al., 1998). "
    [Show abstract] [Hide abstract]
    ABSTRACT: In the elderly, little attention has been paid to anxiety both on a symptom dimension and as a disorder, as an independent risk factor for the incidence of activity limitations. In a community-dwelling cohort of 1581 persons aged 65+, the association between trait anxiety symptoms (Spielberger Trait, third highest tertile) and baseline DSM-IV anxiety disorder, and 7-year incident activity limitations was determined using mixed logistic regression models. Repeated measures of activity limitations included, by increased severity level: social restriction (neighbourhood and house confined), mobility (Rosow and Breslau scale) and limitations in instrumental activities of daily living (IADL). Of the sample, 14.2% had an anxiety disorder at baseline. Adjusting for baseline socio-demographic and health variables, depression (past and current), antidepressant and anxiolytic drugs, baseline anxiety disorder was associated with an increased risk of incident IADL limitation (OR (95% CI): 1.84 (1.01-3.39), p=0.048) and trait anxiety with increased incidence of social restriction (OR (95% CI): 2.41 (1.42-4.09), p=0.001). Associations remained significant in participants free of depressive symptoms at baseline (OR (95% CI): 2.92 (1.41-6.05), p=0.004; OR (95% CI): 3.21 (1.31-7.89), p=0.011, respectively). Activity limitations were self-reported and may have been over-reported in participants with anxiety. Both trait anxiety symptomatology and anxiety disorder were independently associated with increased incidence of activity limitations with a gradient of severity: trait anxiety associated with incident social restriction and anxiety disorder with more severe IADL limitations, suggesting that anxiety is a predictor of activity limitations in the elderly independently of depression comorbidity.
    Journal of Affective Disorders 05/2012; 141(2-3):276-85. DOI:10.1016/j.jad.2012.04.002 · 3.38 Impact Factor
Show more