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Trends and variation in benzodiazepine use in nursing homes in the USA

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

A Correction to this article was published on 16 July 2022

This article has been updated

Abstract

Purpose

Because of toxicities, benzodiazepines are not usually recommended in older adults. We therefore sought to describe the trends in benzodiazepine use in long-term care and examine the variation in benzodiazepine use among nursing homes.

Methods

In this retrospective repeated cross-sectional analysis of Medicare Parts A, B, and D claims data linked to the Minimum Data Set from 2013 to 2018, we included long-term residents who stayed in a nursing home for at least one entire quarter of a calendar year in 2013–2018. The outcome was whether residents were prescribed a benzodiazepine drug for at least 30 days during each quarter stay. We use mixed effects logistic regression models to assess the variation in benzodiazepine use among nursing homes, adjusting for patient and nursing home characteristics.

Results

The cohort for the time trend analysis included 270,566 unique residents and 1,843,580 quarter stays for 2013–2018. Prescribing rates for short-acting benzodiazepines were stable over 2013–2016, then declined from 12.1% in 2016 to 10.6% in 2018. The rate of long-acting benzodiazepine use remained relatively steady at around 4% over 2013–2018. During 2017–2018, the variation among nursing homes in benzodiazepine use was 7.2% for short-acting vs. 9.3% for long-acting benzodiazepines, after controlling for resident characteristics.

Conclusion

Prescribing for short-acting benzodiazepines in long-term care declined after 2016, while long-acting benzodiazepine use did not change. The variation in benzodiazepine use among nursing homes is substantial. Identifying factors that explain this variation may help in developing strategies for deprescribing benzodiazepines in nursing home residents.

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Availability of data and material

The datasets generated during and/or analyzed during the current study are available from the Research Data Assistance Center, The Centers for Medicare and Medicaid Services, https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/ResearchGenInfo/ResearchDataAssistanceCenter.

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Funding

This study was funded by The National Institutes of Health (grants number R01 DA039192, 1 K01 AG070329-01, and P30 AG024832).

Author information

Authors and Affiliations

  1. Sealy Center On Aging, The University of Texas Medical Branch, Galveston, TX, USA

    Ioannis Malagaris

  2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street E7640, Baltimore, MD, 21205, USA

    Hemalkumar B. Mehta

  3. Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, USA

    James S. Goodwin

Authors
  1. Ioannis Malagaris
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  2. Hemalkumar B. Mehta
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  3. James S. Goodwin
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Contributions

Research design and manuscript first draft: all authors. Provision of study materials or patients: James S. Goodwin. Data analysis: Ioannis Malagaris. Final manuscript approval: all authors.

Corresponding author

Correspondence to Hemalkumar B. Mehta.

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Ethics approval

This research study was conducted retrospectively from de-identified data. The UTMB Institutional Review Board approved this study.

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N/A. The UTMB Institutional Review Board waived the requirement for consent to participate/consent to publish because the data was de-identified prior to use.

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The authors declare no competing interests.

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Malagaris, I., Mehta, H.B. & Goodwin, J.S. Trends and variation in benzodiazepine use in nursing homes in the USA. Eur J Clin Pharmacol 78, 489–496 (2022). https://doi.org/10.1007/s00228-021-03244-4

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  • DOI: https://doi.org/10.1007/s00228-021-03244-4

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