Benzodiazepines utilization in Brazilian older adults: a population-based study

Authors

  • Marina de Borba Oliveira Freire Universidade Federal de Pelotas. Faculdade de Medicina. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil https://orcid.org/0000-0002-9307-4337
  • Bruna Gonçalves Cordeiro da Silva Universidade Federal de Pelotas. Faculdade de Medicina. Departamento de Medicina Social. Pelotas, RS, Brasil https://orcid.org/0000-0003-2917-7320
  • Andréa Dâmaso Bertoldi Universidade Federal de Pelotas. Faculdade de Medicina. Departamento de Medicina Social. Pelotas, RS, Brasi https://orcid.org/0000-0002-4680-3197
  • Andréia Turmina Fontanella Universidade Federal do Rio Grande do Sul. Faculdade de Medicina. Programa de Pós-Graduação em Epidemiologia. Porto Alegre, RS, Brasil https://orcid.org/0000-0003-0455-9429
  • Sotero Serrate Mengue Universidade Federal do Rio Grande do Sul. Faculdade de Medicina. Programa de Pós-Graduação em Epidemiologia. Porto Alegre, RS, Brasil https://orcid.org/0000-0002-3349-8541
  • Luiz Roberto Ramos Universidade Federal de São Paulo. Escola Paulista de Medicina. Departamento de Medicina Preventiva. São Paulo, SP, Brasil https://orcid.org/0000-0003-3143-8315
  • Noemia Urruth Leão Tavares Universidade de Brasília. Faculdade de Ciências da Saúde. Departamento de Farmácia. Brasília, DF, Brasil https://orcid.org/0000-0001-6180-7527
  • Tatiane da Silva Dal Pizzol Universidade Federal do Rio Grande do Sul. Faculdade de Farmácia. Departamento de Produção e Controle de Medicamentos. Porto Alegre, RS, Brasil https://orcid.org/0000-0002-7566-7745
  • Paulo Sérgio Dourado Arrais Universidade Federal do Ceará. Faculdade de Farmácia, Odontologia e Enfermagem. Departamento de Farmácia. Fortaleza, CE, Brasil https://orcid.org/0000-0002-4502-8467
  • Mareni Rocha Farias Universidade Federal de Santa Catarina. Centro de Ciências da Saúde. Departamento de Ciências Farmacêuticas. Florianópolis, SC, Brasil https://orcid.org/0000-0002-4319-9318
  • Vera Lucia Luiza Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Departamento de Política de Medicamentos e Assistência Farmacêutica. Rio de Janeiro, RJ, Brasil https://orcid.org/0000-0001-6245-7522
  • Maria Auxiliadora Oliveira Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Departamento de Política de Medicamentos e Assistência Farmacêutica. Rio de Janeiro, RJ, Brasil https://orcid.org/0000-0003-2400-536X
  • Ana Maria Baptista Menezes Universidade Federal de Pelotas. Faculdade de Medicina. Departamento de Medicina Social. Pelotas, RS, Brasil https://orcid.org/0000-0002-2996-9427

DOI:

https://doi.org/10.11606/s1518-8787.2022056003740

Keywords:

Aged, Drug Utilization, Benzodiazepines, Risk Factors, Cross-Sectional Studies

Abstract

OBJECTIVE: To evaluate the utilization of benzodiazepines (BZD) in Brazilian older adults, based on the Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM - National Survey of Access, Use and Promotion of Rational Use of Medicines). METHODS: The PNAUM is a cross-sectional study conducted between 2013 and 2014, representing the Brazilian urban population. In the present study, we included 60 years or older (n = 9019) individuals. We calculated the prevalence of BZD utilization in the 15 days prior to survey data collection according to independent variables, using a hierarchical Poisson regression model. A semistructured interview performed empirical data collection (household interview). RESULTS: The prevalence of BZD utilization in the older adults was 9.3% (95%CI: 8.3–10.4). After adjustments, BZD utilization was associated with female sex (PR = 1.88; 95%CI: 1.52–2.32), depression (PR = 5.31; 95%CI: 4.41–6, 38), multimorbidity (PR = 1.44; 95%CI: 1.20–1.73), emergency room visit or hospitalization in the last 12 months (PR = 1.42; 95%CI: 1.18–1.70 ), polypharmacy (PR = 1.26; 95%CI: 1.01–1.57) and poor or very poor self-rated health (PR = 4.16; 95%CI: 2.10–8.22). Utilization was lower in the North region (PR = 0.18; 95%CI: 0.13–0.27) and in individuals who reported abusive alcohol consumption in the last month (PR = 0.42; 95%CI: 0.19–0.94). CONCLUSION: Despite contraindications, results showed a high prevalence of BZD utilization in older adults, particularly in those with depression, and wide regional and sex differences.

References

Fiorelli K, Assini FL. A prescrição de benzodiazepínicos no Brasil: uma análise da literatura. ABCS Health Sci. 2017;42(1):40-4.

Azevedo AJP, Araújo AA, Ferreira MAF. Consumo de ansiolíticos benzodiazepínicos: uma correlação entre dados do SNGPC e indicadores sociodemográficos nas capitais brasileiras. Cienc Saude Coletiva. 2016;21(1):83-90. https://doi.org/10.1590/1413-81232015211.15532014

Madruga CS, Paim TL, Palhares HN, Miguel AC, Massaro LTS, Caetano R, et al. Prevalence of and pathways to benzodiazepine use in Brazil: the role of depression, sleep, and sedentary lifestyle. Braz J. Psichiatry. 2019;41(1):44-50. https://doi.org/10.1590/1516-4446-2018-0088

Kurko TA, Saastamoinen LK, Tähkäpää S, Tuulio-Henriksson A, Taiminen T, Tiihonen J, et al. Long-term use of benzodiazepines: definitions, prevalence and usage patterns – a systematic review of register-based studies. Eur Psychiatry. 2015;30(8):1037-47. https://doi.org/10.1016/j.eurpsy.2015.09.003

Carrière I, Mura T, Pérès K, Norton J, Jaussent I, Edjolo A, et al. Elderly benzodiazepine users at increased risk of activity limitations: influence of chronicity, indications, and duration of action: the three-city cohort. Am J Geriatr Psychiatry. 2015;23(8):840-51. https://doi.org/10.1016/j.jagp.2014.10.006

American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2019 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2019;67(4):674-94

Cunningham CM, Hanley GE, Morgan S. Patterns in the use of benzodiazepines in British Columbia: examining the impact of increasing research and guideline cautions against long-term use. Health Policy. 2010;97(2-3):122-9. https://doi.org/10.1016/j.healthpol.2010.03.008

Ramos LR, Tavares NUL, Bertoldi AD, Farias MR, Oliveira MA, Luiza VL, et al. Polifarmácia e polimorbidade em idosos no Brasil: um desafio em saúde pública. Rev Saude Publica 2016;50 Supl 2:9s. https://doi.org/10.1590/S1518-8787.2016050006145

Ministério da Saúde (BR), Secretaria de Ciência, Tecnologia e Insumos Estratégicos, Departamento de Assistência Farmacêutica e Insumos Estratégicos; Comitê Nacional para Promoção do Uso Racional de Medicamentos. Uso de medicamentos e medicalização da vida: recomendações e estratégias. Brasília, DF; 2019 [citado 23 nov 2019]. Disponível em: https://portalarquivos2.saude.gov.br/images/pdf/2019/fevereiro/14/ERRATA-Livro-USO-DE-MEDICAMENTOS-E-MEDICALIZACAO-DA-VIDA.pdf

Mengue SS, Bertoldi AD, Boing AC, Tavares NUL, Dal Pizzol TS, Oliveira MA, et al. Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM): métodos do inquérito domiciliar. Rev Saude Publica. 2016;50 Supl 2:4s. https://doi.org/10.1590/S1518-8787.2016050006156

WHO Collaborating Centre for Drug Statistics Methodology. ATC/DDD Index 2018. Oslo (NO); 2019.

Associação Brasileira de Empresas de Pesquisa. Critério de Classificação Econômica Brasil 2013. São Paulo: ABEP; 2013.

Aljawadi MH, Khoja AT, Alhammad AM, AlOtaibi AD, Al-Shammari SA, Khoja TA. The prevalence of benzodiazepines utilization and its association with falls among Saudi older adults; results from the Saudi National Survey for Elderly Health (SNSEH). Saudi Pharm J. 2018;26(8):1112-9. https://doi.org/10.1016/j.jsps.2018.05.022

Fourrier A, Letenneur L, Dartigues JF, Moore N, Bégaud B. Benzodiazepine use in an elderly community-dwelling population. Characteristics of users and factors associated with subsequent use. Eur J Clin Pharmacol. 2001;57(5):419-25. https://doi.org/10.1007/s002280100326

Rikala M, Korhonen MJ, Sulkava R, Hartikainen S. Psychotropic drug use in community-dwelling elderly people-characteristics of persistent and incident users. Eur J Clin Pharmacol. 2011;67(7):731-9. https://doi.org/10.1007/s00228-011-0996-5

Cheng JS, Huang WF, Lin KM, Shih YT. Characteristics associated with benzodiazepine usage in elderly outpatients in Taiwan. Int J Geriatr Psychiatry. 2008;23(6):618-24. https://doi.org/10.1002/gps.1950

Ministério da Saúde (BR), Secretaria de Ciência, Tecnologia e Insumos Estratégicos, Departamento de Assistência Farmacêutica e Insumos Estratégicos. Relação Nacional de Medicamentos Essenciais: RENAME 2018. Brasília, DF; 2018 [citado 23 nov 2019]. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/medicamentos_rename.pdf

Cunha CDA, Souza MCC, Cattanio GAA, Iahnn SR, Lima RC. Benzodiazepine use and associated factors in elderly in the city of Dourados, MS, Brazil. J Bras Psiquiatr. 2015;64(3):207-12. https://doi.org/10.1590/0047-2085000000080

Stowell KR, Chang CC, Bilt J, Stoehr GP, Ganguli M. Sustained benzodiazepine use in a community sample of older adults. J Am Geriatr Soc. 2008;56(12):2285-91. https://doi.org/10.1111/j.1532-5415.2008.02011.x

Boyd A, Van de Velde S, Pivette M, Ten Have M, Florescu S, O'Neill S, et al. Gender differences in psychotropic use across Europe: results from a large cross-sectional, population-based study. Eur Psychiatry. 2015;30(6):778-88. https://doi.org/10.1016/j.eurpsy.2015.05.001

Cumming RG, Le Couteur DG. Benzodiazepines and risk of hip fractures in older people: a review of the evidence. CNS Drugs. 2003;17(11):825-37. https://doi.org/10.2165/00023210-200317110-00004

Scheffer M, coordenador. Demografia Médica no Brasil 2020. São Paulo: Departamento de Medicina Preventiva da Faculdade de Medicina da USP; Conselho Federal de Medicina; 2020.

Ramos LR, Mari JJ, Fontanella AT, Pizzol TSD, BertoldI AD, Mengue SS; PNAUM Research Group. Nationwide use of psychotropic drugs for treatment of self-reported depression in the Brazilian urban adult population. Rev Bras Epidemiol. 2020;23:E200059. https://doi.org/10.1590/1980-549720200059

Valenstein M, Taylor KK, Austin K, Kales HC, McCarthy JF, Blow FC, et al. Benzodiazepine use among depressed patients treated in mental health settings. Am J Psychiatry 2004;161(4):654-61. https://doi.org/10.1176/appi.ajp.161.4.654

Furukawa TA, Streiner DL, Young LT. Antidepressant and benzodiazepine for major depression. Cochrane Database Syst Rev. 2002;(1):CD001026. https://doi.org/10.1002/14651858.CD001026

Bendtsen P, Hensing G, McKenzie L, Stridsman AK. Prescribing benzodiazepines: a critical incident study of a physician dilemma. Soc Sci Med 1999;49(4):459-67. https://doi.org/10.1016/s0277-9536(99)00133-1

Nastasy H, Ribeiro M, Marques ACPR. Associação Brasileira de Psiquiatria. Abuso e Dependência de Benzodiazepínicos. Projeto Diretrizes. 2008.

Gress T, Miller M, Meadows C III, Neitch SM. Benzodiazepine overuse in elders: defining the problem and potential solutions. Cureus. 2020;12(10):e11042. https://doi.org/10.7759/cureus.11042

World Health Organization. Coronavirus disease 2019 (COVID 19): situation report, 51. Geneva (CH): WHO: 2020 [citado 2 abr 2020]. Disponível em: https://apps.who.int/iris/bitstream/handle/10665/331475/nCoVsitrep11Mar2020-eng.pdf?sequence=1&isAllowed=y

Smith BJ, Lim MH. How the COVID-19 pandemic is focusing attention on loneliness and social isolation. Public Health Res Pract. 2020;30;30(2):3022008. https://doi.org/10.17061/phrp3022008

Published

2022-03-11

Issue

Section

Original Articles

How to Cite

Freire, M. de B. O., Silva, B. G. C. da, Bertoldi, A. D., Fontanella, A. T., Mengue, . S. S., Ramos, L. R., Tavares, N. U. L., Pizzol, T. da S. D. ., Arrais, P. S. D., Farias, M. R., Luiza, V. L., Oliveira, M. A., & Menezes, A. M. B. (2022). Benzodiazepines utilization in Brazilian older adults: a population-based study. Revista De Saúde Pública, 56, 10. https://doi.org/10.11606/s1518-8787.2022056003740

Funding data