Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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1051 — Trends in Prevalent and Incident Benzodiazepine Use Among Older Veterans: 2010-2016

Lead/Presenter: Donovan Maust, COIN - Ann Arbor
All Authors: Maust DT (Ann Arbor) Bohnert AS (Ann Arbor) Blow FC (Ann Arbor) Ignacio RV (Ann Arbor) Hofer TP (Ann Arbor) Kerr EA (Ann Arbor)

Objectives:
The American Geriatrics Society considers nearly all benzodiazepine (BZD) use among older adults inappropriate because use is associated with increase fall risk and worsened cognition. Yet, BZD prescribing among older adults in the US is steady or has even increased: a recent analysis estimated that 8.6% of adults 65+ years filled a BZD prescription in 2013. Trends in prescribing of BZDs for older Veterans in VHA care are unknown. While interventions to reduce BZD use frequently focus on stopping medications, even short-term use can have negative consequences. We therefore examined how often older Veterans are continued on or newly prescribed BZD in order to better understand how to target future interventions.

Methods:
Using the Corporate Data Warehouse (CDW), we determined rates of any BZD use and incident use (i.e., a new BZD prescription in a patient without a BZD claim in the preceding 12 months) among Veterans 65+ years of age between 2010 and 2016, stratified by age (65-74, 75-84, and 85+). We examined overall medical comorbidity and the presence of specific psychiatric diagnoses among incident users in the last half of FY2015.

Results:
From 2010 to 2016, the prevalence of BZD prescriptions among older Veterans decreased from 7.4% to 5.8%. By 2016, the rate of BZD prescriptions was lowest among the 85+ group at 3.4%. While the majority (88.5%) of BZD use is not new use, 21,539 elderly Veterans who had not been prescribed a BZD in the prior 12 months received a new prescription during the last half of FY 2015. Incident users were more medically ill than non-BZD users: 32.7% had a Charlson score > = 2 compared to 24.0% of non-BZD users. Incident users were more likely than non-users to have a diagnosis of PTSD (18.6% v. 9.4%) or insomnia (10.1% v. 4.8%); depression was their most common psychiatric diagnosis (26.6% v. 13.2%; p < 0.001 for all incident BZD to non-user comparisons). Nearly 25% of new BZD users had no mental health or insomnia diagnosis recorded.

Implications:
The absolute rate of BZD use among elderly Veterans dropped 1.6% from 2010-2016 (a relative reduction of 21.6%) in apparent contrast to use among the general population of older adults in the U.S.

Impacts:
Despite the drop in overall use, a large number of elderly Veterans still receive new BZD prescriptions for unclear indications, which warrants additional attention.