Pharmacoepidemiology and drug safety · 2026
Trajectories Associated With the Use and Deprescription of Benzodiazepines and Z-Drugs in a Network of Geriatric Outpatient Clinics.
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do Carmo Júnior Nelson Machado, do Nascimento Mariana Martins Gonzaga, de Loyola Filho Antônio Ignácio, Azevedo Daniela Castelo, Valle Estevão Alves, Reis Edna Afonso
Аннотация
PURPOSE: To determine the trajectories of benzodiazepine (BZD) and Z-drug use among older adults (n = 3590) followed in a network of geriatric outpatient clinics in Brazil.
METHODS: This longitudinal study evaluated BZD and Z-drug use over a 24-month follow-up period. The proportion of use at baseline and at the end of the study period was compared using the McNemar test. Two trajectories were considered: started using and stopped using. Comparisons between trajectories and independent variables were performed using Pearson's chi-square test. Variables with p < 0.20 were eligible for multivariate analysis. Multivariate models were also used to identify factors associated with BZD or Z-drug use at baseline and with trajectories of initiation and discontinuation. Odds ratios (OR) with 95% confidence intervals were estimated.
RESULTS: A small but significant reduction in overall BZD or Z-drug use was observed (17.4% to 16.0%; p = 0.007), with a marked decrease in isolated Z-drug use (6.1% to 4.0%; p < 0.001). At baseline, use was associated with female sex (OR = 1.48; 95% CI 1.19-1.84), age 60-74 years (OR = 1.64; 95% CI 1.29-2.10), having ≥ 2 fall-related conditions (OR = 2.53; 95% CI 1.94-3.31), higher frailty scores, and cognitive dysfunction (OR = 1.32; 95% CI 1.00-1.74). Initiation was associated with pharmacist consultations during follow-up (OR = 5.01; 95% CI 2.88-8.71), depression (OR = 2.59; 95% CI 1.80-3.73), insomnia (OR = 1.97; 95% CI 1.19-3.25), and panic syndrome. Pharmacist consultation was also associated with discontinuation (OR = 0.34; 95% CI 0.15-0.76).
CONCLUSIONS: Clinical vulnerability and psychiatric conditions were associated with BZD or Z-drug use and initiation, while pharmacist consultations were associated with both initiation and discontinuation trajectories.
METHODS: This longitudinal study evaluated BZD and Z-drug use over a 24-month follow-up period. The proportion of use at baseline and at the end of the study period was compared using the McNemar test. Two trajectories were considered: started using and stopped using. Comparisons between trajectories and independent variables were performed using Pearson's chi-square test. Variables with p < 0.20 were eligible for multivariate analysis. Multivariate models were also used to identify factors associated with BZD or Z-drug use at baseline and with trajectories of initiation and discontinuation. Odds ratios (OR) with 95% confidence intervals were estimated.
RESULTS: A small but significant reduction in overall BZD or Z-drug use was observed (17.4% to 16.0%; p = 0.007), with a marked decrease in isolated Z-drug use (6.1% to 4.0%; p < 0.001). At baseline, use was associated with female sex (OR = 1.48; 95% CI 1.19-1.84), age 60-74 years (OR = 1.64; 95% CI 1.29-2.10), having ≥ 2 fall-related conditions (OR = 2.53; 95% CI 1.94-3.31), higher frailty scores, and cognitive dysfunction (OR = 1.32; 95% CI 1.00-1.74). Initiation was associated with pharmacist consultations during follow-up (OR = 5.01; 95% CI 2.88-8.71), depression (OR = 2.59; 95% CI 1.80-3.73), insomnia (OR = 1.97; 95% CI 1.19-3.25), and panic syndrome. Pharmacist consultation was also associated with discontinuation (OR = 0.34; 95% CI 0.15-0.76).
CONCLUSIONS: Clinical vulnerability and psychiatric conditions were associated with BZD or Z-drug use and initiation, while pharmacist consultations were associated with both initiation and discontinuation trajectories.