What is the point of guidelines? Benzodiazepine and z-hypnotic use by an elderly population

Background: According to published guidelines regarding the use of benzodiazepines or z-hypnotics (BZD-Z), the elderly should avoid hypnotic BZD, and use anxiolytic BZD and z-hypnotics only at low doses and for a short time. Our objective is to quantify inappropriate BZD-Z use in the elderly. Methods: The study population consisted of people aged 70-89 who filled at least two prescriptions in 2008 within one of three subgroups: anxiolytic BZD, hypnotics BZD, or z-hypnotics. Inappropriate use criteria used for this study were (1) any hypnotic BZD, (2) exceeding 300 DDD, or a dosage exceeding 9 DDD/week, or anxiolytic BZD and z-hypnotics use exceeding 30 weeks. Results: 118,526 persons, or 25% of elderly Norwegians, filled at least two prescriptions for one of these medication subgroups. Inappropriate use was found for 25% of anxiolytic BZD users, 100% of hypnotic BZD users, and 65% of z-hypnotic users. Altogether 57,276 elderly Norwegians, or 12.3% of the elderly source population, used BZD-Z inappropriately as defined in this study. Conclusions: Clearly, inappropriate use of BZD-Z is widespread. An active response to such noncompliance with existing guidelines could consist of either (1) stricter enforcement of guidelines or (2) revamping guidelines through a fresh look at risks, benefits, and treatment practices. The implications of both options are discussed in some detail. (C) 2012 Published by Elsevier B.V.