Main Article Content
Benzodiazepines, zopiclone, STOPP criteria, screening tool, inappropriate prescribing, aged
Optimization of prescribing in older adults is needed. The STOPP criteria provide a systematic way of identifying potentially inappropriate prescribing in this population. Previous research indicates poor concordance between benzodiazepine prescribing and STOPP.
To determine the extent and predictors of benzodiazepine and zopiclone (BZD -Z) pharmacy dispensations in older adults with a history of a recent fall, in concordance with STOPP.
Prescription claims data from the Nova Scotia Sen iors’ Phamacare Program were linked with fall -related injury data from the CIHI Discharge Abstract Database. Adults aged ≥ 66 years making a claim for a BZD -Z in the 100 days prior to fall -related hospitali zation were identified. Their BZD -Z claims in the 100 days following discharge were also identified. Descriptive statistics, trend tests and logistical regression modelling were performed to examine predictors for continued use of BZD -Z post -fall.
Over 5 years, from a pool of 8,271 older adults discharged following a fall -related hospitalization, 1,789 (21.6%) had made a claim for a BZD -Z in the 100 days prior to admission. Of these, 82% were women. Younger age and female sex were predictors of continuing BZD -Z dispensations post -fall. In the 100 days following discharge, 74.2% (n=1327) made a claim for at least one BZD -Z.
BZD -Z use continued in 74% of patients following discharge from a fall -related hospitalization, representing limited concordance with the STOPP criterion. Such hospitalizations and follow -up care present an opportunity to address an ongoing modifiable risk factor.
2. Tinetti ME, Gordon C, So golow E, Lapin P, Bradley EH. Fall -risk evaluation and management: challenges in adopting geriatric care practices. Gerontologist 2006 Dec;46(6):717 -25.
3. van der Cammen TJ, Rajkumar C, Onder G, Sterke CS, Petrovic M. Drug cessation in complex older adults: time for action. Age Ageing 2014 Jan;43(1):20 -5. doi: 10.1093/ageing/aft166.
4. Canadian Institute for Health Information. Falls among seniors - Atlantic Canada. Ottawa, ON: CIHI; 2013. Available at: http://www.patientsafetyinstitute.ca/en/toolsRe sources/Presentations/Documents/Atlantic%20Hea lth%20Quality%20and%20Patient%20Safety%20 Learning%20Exchange%20(2013)/1%20 - %20EN%20CIHI%20Falls%20data%20 - %20ALE_falls_with%20speakers%20notes%2020 13%2005%2014%20130pm%20- %20240pm.pdf#search=falls%20among%20senior s
5. Huang AR, Mallet L, Rochefort CM, Eguale T, Buckeridge DL, Tamblyn R. Medication -related falls in the elderly: causative factors and preventive strategies. Drugs Aging 2012 May 1;29(5):359 -76. doi: 10.2165/11599460 -000000000- 00000.
6. Finkle WD, Der JS, Greenland S, et al. Risk of fractures requiring hospitalization after an initial prescription for zolpidem, alprazolam, lorazepam, or diazepam in older adults. J Am Geriatr Soc 2011 Oct;59(10):1883 -90. doi: 10.1111/j.1532 - 5415.2011.03591.x.
7. Nurminen J, Puustinen J, Piirtola M, Vahlberg T, Kivelä SL. Psychotropic drugs and the risk of fractures in old age: a prospective population -based study. BMC Public Health 2010 Jul 6;10:396. doi: 10.1186/1471 -2458 -10-396.
8. Gosch M, Wörtz M, Nicholas JA, Doshi HK, Kammerlander C, Lechleitner M. Inappropriate prescribing as a predictor for long- term mortality after hip fracture. Gerontology 2014;60(2):114 -22. doi: 10.1159/000355327.
9. Gallagher P, Ryan C, Byrne S, Kennedy J, O’M ahony D. STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. Int J Clin Pharmacol Ther 2008;46(2):72– 83.
10. Gallagher P, Lang PO, Cherubini A, et al. Prevalence of potentially inappropriate prescribing in an acutely ill population of older patients admitted to six European hospitals. Eur J Clin Pharmacol 2011 Nov;67(11):1175 -88. doi: 10.1007/s00228 -011 -1061 -0.
11. Wahab AMS, NyfortHansen K, Kowalski SR. Inappropriate prescrib ing in hospitalised Australian elderly as determined by the STOPP criteria. Int J Clin Pharm 2012;34(6):85562.
12. McMahon CG, Cahir CA, Kenny RA, Bennett K. Inappropriate prescribing in older fallers presenting to an Irish emergency department. Age Ageing 2014 Jan;43(1):44 -50. doi: 10.1093/ageing/aft114.
13. de Vries OJ1, Peeters G, Elders P, et al. The elimination half -life of benzodiazepines and fall risk: two prospective observational studies. Age Ageing 2013 Nov;42(6):76470. doi: 10.1093/ageing/aft089.
14. Davi la Barboza YR, Azana Fernandez EH. Outcome of elderly hip fracture patients admitted to an acute orthogeriatric unit. European Geriatric Medicine 2013;4(S1): 68.
15. Hohmann N, Hohmann L, Kruse M. The impact of combined use of fallrisk medications and antithr ombotics on injury severity and intracranial hemorrhage among older trauma patients. Geriatric Nursing 2014;35(1):20 -25.
16. Hill -Taylor BJ, Sketris IS, Gardner DM, Thompson K, Haughn C. Benzodiazepine and zopiclone prescription claims by older adults in Nova Scotia: Trends and concordance with the Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP). International Symposium on Health Information Management Research (ISHIMR) 2013 Conference Proceedings, Halifax, NS. June 26-28, 2013. Available at: http://ppr.cs.dal.ca/ishimr/ 17. Department of Health and Wellness, Government of Nova Scotia. Corporate Reports 2014 -2105. Available at: http://novascotia.ca/dhw/corporate - reports/documents/DHW_Statement_of_Mandate_ for_2014 -2015.pdf
18. MSI Health Information Department, Medavie Blue Cross for the Nova Scotia Department of Health and Wellness. Annual Statistical Tables: 12 months ending March 21, 2011 with comparative statistics for previous years. Sept 2011. Available at: http://novascot ia.ca/dhw/publications/annual - statistical - reports/DOH_Annual_Stat_Report_MSI_2010_11. pdf
19. Centre for Health Information, Newfoundland and Labrador. Seniors’ Falls Statistics. Sept 2012. Available at: http://nlchi.nl.ca/images/Senior%20Falls%20Fast %20Facts_September%2017%202012_final.pdf
20. Canadian Institute for Health Information. Drug Use Among Seniors on Public Drug Programs in Canada, 2012. Ottawa, ON: CIHI; 2014. Ava ilable at: https:/secure.cihi.ca/free_products/Drug_Use_in_S eniors_on_Public_Drug_Programs_2012_EN_web .pdf
21. Billioti de Gage S, Moride Y, Ducruet T, et al. Benzodiazepine use and risk of Alzheimer’s disease: case -control study. BMJ 2014;349:g5205.
22. Martin P, Tamblyn R, Ahmed S, Tannenbaum C. An educational intervention to reduce the use of potentially inappropriate medications among older adults (EMPOWER study): protocol for a cluster randomized trial. Trials 2013 Mar 20;14:80. doi: 10.1186/1745 -6215 -14-80.
23. Venn S, Arber S. Understanding older peoples' decisions about the use of sleeping medication: issues of control and autonomy. Sociol Health Illn 2012 Nov;34(8):1215 -29. doi: 10.1111/j.1467 - 9566.2012.01468.x.
24. Gallagher HC. Addressing the issue of chronic, inappropriate benzodiazepine use: How can pharmacists play a role? Pharmacy 2013;1:65 -93. doi:10.3390/pharmacy1020065. Available at: www.mdpi.com/journal/pharmacy
25. Tannenbaum C, Martin P, Tamblyn R, Benedetti A, Ahmed S. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial. JAMA Intern Med 2014 Jun;174(6):890 -8.
26. Zisberg A, Shadmi E, Sinoff G, Gur -Yaish N, Srulovici E, Shochat T. Hospitalization as a turning point for sleep medication use in older adults: prospective cohort study. Drugs Aging 2012 Jul 1;29(7):565 -76. doi: 10.2165/11632350 - 000000000- 00000.
27. García -Gollarte F, Baleriola -Júlvez J, Ferrero - López I, Cruz -Jentoft AJ. Inappropriate drug prescription at nursing home admission. J Am Med Dir Assoc 2012 Jan;13(1):83.e9 -15. doi: 10.1016/j.jamda.2011.02.009.
28. O'Mahony D, O'Sullivan D, Byrne S, O'Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: versi on 2. Age Ageing 2014 Oct 16. pii:afu145. [Epub ahead of print]