European Journal of Clinical Pharmacology

, Volume 68, Issue 5, pp 833–844 | Cite as

Benzodiazepine use in Belgian nursing homes: a closer look into indications and dosages

  • Jolyce BourgeoisEmail author
  • Monique M. Elseviers
  • Majda Azermai
  • Luc Van Bortel
  • Mirko Petrovic
  • Robert R. Vander Stichele
Pharmacoepidemiology and Prescription



(1) To describe the prevalence of benzodiazepine use in Belgian nursing homes, with specific attention to indications and dosages. (2) To compare actual and recommended dosages of benzodiazepines for anxiety and insomnia. (3) To explore the risk profile for chronic benzodiazepine use in institutionalised older adults.


Medication charts of 1,730 residents from 76 nursing homes in Belgium were collected and analysed, using the ATC classification. Drug name, indication and daily dosage were recorded. From authoritative international sources, we extracted for each drug and each indication a daily dosage recommended not to be exceeded in older adults for comparison with observed actual dosages.


Among the chronic benzodiazepine or z-drug (BZD/Z) users (50% of the residents), the leading indication was ‘insomnia’ (59% of the users) followed by ‘anxiety’ (17%) and ‘unrest’ (10%). In the chronic prescriptions of BZD/Zs indicated for insomnia, the actual daily dose exceeded the geriatric upper limit in 95% of lormetazepam prescriptions, 82% of zolpidem, 78% of zopiclone and 35% of lorazepam prescriptions. For anxiety, daily doses also exceeded the limit but not to the same extent. Multivariate analysis showed BZD/Z use was positively associated with pain (OR 1.58, 95% CI 1.27–1.97), constipation (OR 1.43, 95% CI 1.16–1.76) and depression (OR 1.68, 95% CI 1.35–2.08). Residents with dementia were less likely to receive a BZD/Z (OR 0.60, 95% CI 0.48–0.74).


Efforts to reduce the use of BZD/Zs in nursing homes should concentrate on insomnia, with interventions aimed at reducing too high prevalence of chronic use and too high daily dosages in this indication.


Benzodiazepines Aged Drug utilisation Pharmacoepidemiology 



We thank Prof. Dr. Thierry Christiaens from the Department of Family Medicine and Primary Care and Dr. Hans Debruyne, psychiatrist at the Dr. Guislain Centre for Psychiatry, for their contribution.

Competing interest

There are no competing interests to declare.


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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Jolyce Bourgeois
    • 1
    Email author
  • Monique M. Elseviers
    • 1
    • 2
  • Majda Azermai
    • 1
  • Luc Van Bortel
    • 1
  • Mirko Petrovic
    • 1
    • 3
  • Robert R. Vander Stichele
    • 1
  1. 1.Heymans Institute of PharmacologyGhent UniversityGhentBelgium
  2. 2.Department of Nursing ScienceUniversity of AntwerpAntwerpBelgium
  3. 3.Service of GeriatricsGhent University HospitalGhentBelgium

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