Skip to main content
SpringerLink
Log in

Quality analysis of research on the use of benzodiazepines by elderly patients in the emergency room:a systematic review

  • Review Article
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

To analyze the quality of research on the use of benzodiazepines (BZDs) in the emergency room by the elderly population through the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiative.

Methods

A systematic review was carried out according to the following steps: (1) identification of studies, in which studies were selected from different combinations of the descriptors “elderly–aged,” “benzodiazepines,” and “emergency room” in the EMBASE–MEDLINE, SciELO, Scopus, and Web of Science databases; (2) evaluation of studies, in which the title, abstract, and full text of the studies were assessed; (3) evaluation of the methodological quality of the studies. The criteria used were those included in the STROBE recommendations.

Results

At the end of the selection process, only six articles were identified which met the specific criteria. The sample sizes in these studies varied from 118 to 1,611 patients. More than half (4) of the studies did not describe the type of design used, whereas all collected demographic data and analyzed details on the use of BZDs, such as type administered and/or its relationship to the symptoms, were shown. No article fully complied with the STROBE criteria.

Conclusions

This review shows a lack of methodological quality in the studies performed to date that have evaluated the use of BZDs in elderly patients in emergency rooms. These findings should guide future research in this subject area, providing a more complete approach on aspects related to the use of medications by this specific population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. World Health Organization (2006) Healthy ageing profiles. Guidance for producing local health profiles of older people: report of WHO consultation. World Health Organization, Geneva. Available at: http://www.euro.int/document/E91887.pdf. Accessed 2 Nov 2011

  2. Chen YF, Dewey ME, Avery AJ (2001) The Analysis Group of the MRCCFA Study. Self-reported medication use for older people in England Wales. J Clin Pharm Ther 26:129–140

    Article  PubMed  CAS  Google Scholar 

  3. Sharkey JR, Browne B, Ory MG, Wang S (2005) Patterns of therapeutic medication category use among community-dwelling homebound older adults. Pharmacoepidemiol Drug Saf 14:715–723

    Article  PubMed  Google Scholar 

  4. Center for Behavioral Health Statistics and Quality (2011) Substance Abuse and Mental Health Services Administration. Drug Abuse Warning Network, 2008: national estimates of drug-Related emergency department visits. U.S. Department of Health and Human Services (HHS) publication no. (SMA) 11–4618. HHS, Rockville

  5. Banerjee A, Mbamalu D, Ebrahimi S et al (2011) The prevalence of polypharmacy in elderly attenders to an emergency department—a problem with a need for an effective solution. Int J Emerg Med 4:22

    Google Scholar 

  6. Gurwitz JH, Field TS, Harrold LR et al (2003) Incidence and prevalence of adverse drug events among older persons in the ambulatory setting. JAMA 289:1107–1116

    Article  PubMed  Google Scholar 

  7. Beers MH, Ouslander JG, Rollingher I et al (1991) Explicit criteria for determining inappropriate medication use in nursing home residents. Arch Intern Med 151:1825–1832

    Article  PubMed  CAS  Google Scholar 

  8. Gallagher PF, Barry PJ, Ryan C et al (2008) Inappropriate prescribing in an acutely ill population of elderly patients as determined by Beers’ Criteria. Age Ageing 37:96–101

    Article  PubMed  Google Scholar 

  9. Fick DM, Cooper JW, Wade WE et al (2003) Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med 163:2716–2724

    Article  PubMed  Google Scholar 

  10. Higgins K, Cooper-Stanbury M, Williams (2000) Statistics on drug use in Australia in 1998. Australian Institute of Health and Welfare, Canberra

    Google Scholar 

  11. Neutel CI (2005) The epidemiology of long-term benzodiazepine use. Int Rev Psychiatry 17:189–197

    Article  PubMed  Google Scholar 

  12. Fritsch MR, Rojas CG, Gaete OJ et al (2005) Benzodiazepine use in Santiago, Chile. Actas Esp Psiquiatr 33:286–291

    Google Scholar 

  13. Ciuna A, Andretta M, Corbari L (2004) Are we going to increase the use of antidepressants up to that of benzodiazepines? Eur J Clin Pharmacol 60:629–634

    Article  PubMed  CAS  Google Scholar 

  14. Vedia UC, Bonet M, Forcada V et al (2005) Estudio de utilización de psicofármacos en atención primaria. Aten Primaria 36:239–245

    Article  Google Scholar 

  15. Groenwold RH, Van Deursen AM, Hoes AW et al (2008) Poor quality of reporting confounding bias in observational intervention studies: a systematic review. Ann Epidemiol 18:746–751

    Article  PubMed  Google Scholar 

  16. Von Elm E, Altman DG, Egger M (2007) Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Br Med J 335:806–808

    Article  Google Scholar 

  17. Hosmer DW, Lameshow S (1989) Applied logistic regression. Wiley, New York

    Google Scholar 

  18. Moher D, Liberati A, Tetzlaff J et al (2008) The PRISMA group preferred reporting items for systematic reviews and meta-analyses: thePRISMA statement. PLoS Med 6:e1000097. doi:10.1371/journal.pmed.1000097

    Article  Google Scholar 

  19. Spanemberg L, Nogueira EL, Silva CTB et al (2011) High prevalence and prescription of benzodiazepines for elderly: data from psychiatric consultation to patients from an emergency room of a general hospital. Gen Hosp Psychiatry 33:45–50

    Article  PubMed  Google Scholar 

  20. Kurtzthaler I, Wambacher M, Golser K et al (2005) Alcohol and/or benzodiazepine use: different accidents–different impacts? Hum Psychopharmacol 20:583–589

    Article  Google Scholar 

  21. Heininger-Rothbucher D, Daxecker M, Ulmer H et al (2003) Problematic drugs in elderly patients presenting to a European emergency room. Eur J Intern Med 14:372–376

    Article  PubMed  Google Scholar 

  22. Pierfitte C, Macouillard G, Thicoipe M et al (2001) Benzodiazepines and hip fractures in elderly people: case–control study. Br Med J 322:704–708

    Article  CAS  Google Scholar 

  23. Verhaeghe W, Mets T, Corne L (1996) Benzodiazepines use among elederly patients presenting at the emergency room. Arch Gerontol Geriatr 22:55–62

    Article  PubMed  CAS  Google Scholar 

  24. Puryear DA, Lovitt R, Miller DA (1991) Characteristics of elderly persons seen in a urban psychiatric emergency room. Hosp Community Psychiatry 42:802–807

    PubMed  CAS  Google Scholar 

  25. Cascadee KAH, Kwentus JA et al (2009) Trends in CNS prescribing following the economic slowdown. Psychiatry (Edgmont) 6:15–17

    Google Scholar 

  26. Ravera S, Hummel SA, Stolk P et al (2009) The use of driving impairing medicines: a European survey. Eur J Clin Pharmacol 69:1139–1147

    Article  Google Scholar 

  27. Furtado C, Teixeira I (2006) Utilização de benzodiazepinas em Portugal continental (1999–2003). Acta Med Port 19:239–246

    PubMed  Google Scholar 

  28. International Narcotics Control Board (INCB) (2010) Report of the International Narcotics Control Board for 2009. INCB, Vienna

  29. Touchette DR, Shapiro NL (2008) Medication compliance, adherence and persistence: current status of behavioral and educational interventions to improve outcomes. J Manag Care Pharm 14:S2–S10

    Google Scholar 

  30. Allen MH, Currrier GW (2004) Use of restraints and pharmacotherapy in academic psychiatric emergency services. Gen Hosp Psychiatry 26:42–49

    Article  PubMed  Google Scholar 

  31. Sweetman SC (2005) Martindale: the complete drug reference. Pharmaceutical Press, London

    Google Scholar 

  32. Sampol G, Rodes G, Rios J (2010) Acute hypercapnic respiratory failure in patients with sleep apneas. Arch Bronconeumol 46:466–472

    Article  PubMed  Google Scholar 

  33. Schneider DL (2002) Insomnia. Safe and effective therapy for sleep problems in the older patient. Geriatrics 57:24–32

    PubMed  Google Scholar 

  34. Helbrook A, Crowther R, Lotter A (2001) The role of benzodiazepines in the treatment of insomnia: Meta-analysis of benzodiazepine use in the treatment of insomnia. J Am Geriatr Soc 49:824–826

    Article  Google Scholar 

  35. Woolcott JC, Richardson KJ, Wiens MD et al (2009) Meta analysis of the impact of 9 medication classes on falls in elderly persons. Arch Inter Med 169:1952–1960

    Article  Google Scholar 

  36. Hartikainen S, Lönnroos E (2010) Systematic review: use of sedatives and hypnotics, antidepressants and benzodiazepines in older people significantly increases their risk of falls. Evid Based Med 15:59. doi:10.1136/ebm1058

    Google Scholar 

  37. Young AS, Sullivan G, Burnam MA et al (1998) Measuring the quality of outpatient treatment for schizophrenia. Arch Gen Psychiatry 55:611–617

    Article  PubMed  CAS  Google Scholar 

  38. Lilford R, Mohammed M, Spiegelhalter D et al (2004) Use and misuse of process and outcome data in managing performance of acute medical care: avoiding institutional stigma. Lancet 363:1147–1154

    Article  PubMed  Google Scholar 

  39. Murff HJ, Patel VL, Hripcsak G et al (2003) Detecting adverse events for patient safety research: a review of current methodologies. JAMA 36:131–143

    Google Scholar 

  40. Sayer GP, McGeechan K, Kemp A et al (2003) The general practice research network: the capabilities of an electronic patient management system for longitudinal patient data. Pharmacoepidemiol Drug Saf 12:483–489

    Article  PubMed  Google Scholar 

  41. Wang SJ, Middleton B, Prosser LA et al (2003) A cost–benefit analysis of electronic medical records in primary care. Am J Med 114:397–403

    Article  PubMed  Google Scholar 

  42. Bates DW, Teich JM, Lee J et al (1999) The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc 64:313–321

    Article  Google Scholar 

  43. Jüni P, Altman DG, Egger M (2001) Systematic reviews in health care: assessing the quality of controlled clinical trials. Br Med J 323:42–46

    Article  Google Scholar 

  44. Egger M, Schneider M, Davey Smith G (1998) Spurious precision? Meta-analysis of observational studies. Br Med J 316:140–144

    Article  CAS  Google Scholar 

  45. Mellingsaeter TC, Bramness JG, Slørdal L (2006) Are z-hypnotics better and safer sleeping pills than benzodiazepines? Tidsskr Nor Laegeforen 126:2954–2956

    PubMed  Google Scholar 

  46. Hausken AM, Furu K, Skurtveit S, Engeland A, Bramness JG (2009) Starting insomnia treatment: the use of benzodiazepines versus z-hypnotics. A prescription database study of predictors. Eur J Clin Pharmacol 65:295–301

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This study was supported by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes).

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Education and Research Laboratory in Social Pharmacy (LEPFS), Physiology Department, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil

    Daniel T. Silva, Carina C. Silvestre & Divaldo P. Lyra Jr

  2. Pre-clinical Pharmacology Laboratory (LAPEC), Physiology Department, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil

    Ana Teresa R. Couto & Lucindo J. Quintans Jr

Authors
  1. Ana Teresa R. Couto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniel T. Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carina C. Silvestre
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Divaldo P. Lyra Jr
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lucindo J. Quintans Jr
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Couto, A.T.R., Silva, D.T., Silvestre, C.C. et al. Quality analysis of research on the use of benzodiazepines by elderly patients in the emergency room:a systematic review. Eur J Clin Pharmacol 69, 1343–1350 (2013). https://doi.org/10.1007/s00228-012-1439-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00228-012-1439-7

Keywords

Search

Navigation