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.

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Available from: Shelly L Gray, Aug 11, 2014
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    • "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). "
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    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.
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    • "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. "
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    • "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). "
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