BACKGROUND: The use of benzodiazepines (BZDs) in older population is often accompanied by drug-related complications. Inappropriate BZD use significantly alters older adults' clinical and functional status. This study compares the prevalence, prescribing patterns and factors associated with BZD use in community-dwelling older patients in 7 European countries. METHODS: International, cross-sectional study was conducted in community-dwelling older adults (65 +) in the Czech Republic, Serbia, Estonia, Bulgaria, Croatia, Turkey, and Spain between Feb2019 and Mar2020. Structured and standardized questionnaire based on interRAI assessment scales was applied. Logistic regression was used to evaluate factors associated with BZD use. RESULTS: Out of 2,865 older patients (mean age 73.2 years ± 6.8, 61.2% women) 14.9% were BZD users. The highest prevalence of BZD use was identified in Croatia (35.5%), Spain (33.5%) and Serbia (31.3%). The most frequently prescribed BZDs were diazepam (27.9% of 426 BZD users), alprazolam (23.7%), bromazepam (22.8%) and lorazepam (16.7%). Independent factors associated with BZD use were female gender (OR 1.58, 95%CI 1.19-2.10), hyperpolypharmacy (OR 1.97, 95%CI 1.22-3.16), anxiety (OR 4.26, 95%CI 2.86-6.38), sleeping problems (OR 4.47, 95%CI 3.38-5.92), depression (OR 1.95, 95%CI 1.29-2.95), repetitive anxious complaints (OR 1.77, 95%CI 1.29-2.42), problems with syncope (OR 1.78, 95%CI 1.03-3.06), and loss of appetite (OR 0.60, 95%CI 0.38-0.94). In comparison to Croatia, residing in other countries was associated with lower odds of BZD use (ORs varied from 0.49 (95%CI 0.32-0.75) in Spain to 0.01 (95%CI 0.00-0.03) in Turkey), excluding Serbia (OR 1.11, 95%CI 0.79-1.56). CONCLUSIONS: Despite well-known negative effects, BZDs are still frequently prescribed in older outpatient population in European countries. Principles of safer geriatric prescribing and effective deprescribing strategies should be individually applied in older BZD users.

Center for Applied Pharmacy Faculty of Pharmacy and Biochemistry University of Zagreb Zagreb Croatia

Clinical Pharmacy and Pharmaceutical Care Unit Department of Pharmacy and Pharmaceutical Technology and Physical Chemistry Faculty of Pharmacy and Food Sciences University of Barcelona Barcelona Spain

Connell School of Nursing Boston College Chestnut Hill MA USA

Department of Clinical Pharmacy Faculty of Pharmacy Marmara University Istanbul Turkey

Department of General Practice Amsterdam Public Health Research Institute Amsterdam University Medical Center Vrije Universiteit Amsterdam The Netherlands

Department of Geriatrics and Gerontology 1st Faculty of Medicine Prague Charles University Prague Czech Republic

Department of Social and Clinical Pharmacy Research Group Ageing Polypharmacy and Changes in the Therapeutic Value of Drugs in the Aged Faculty of Pharmacy in Hradec Králové Charles University Heyrovského 1203 Hradec Králové 500 05 Czech Republic

Department of Statistical Modelling Institute of Computer Science of the Czech Academy of Sciences Prague Czech Republic

Faculty of Medicine Institute of Pharmacy University of Tartu Tartu Estonia

Faculty of Pharmacy Medical University of Sofia Sofia Bulgaria

Faculty of Pharmacy University of Belgrade Belgrade Serbia

Finnish Institute for Health and Welfare Helsinki Finland

Fondazione Policlinico Universitario A Gemelli IRCCS Rome Italy

The Hinda and Arthur Marcus Institute for Aging Research Hebrew Senior Life Boston MA USA

Università Cattolica del Sacro Cuore Rome Italy

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Polypharmacy and potentially inappropriate prescribing of benzodiazepines in older nursing home residents