[Potentially inappropriate benzodiazepine prescriptions in elderly nursing home patients]

To evaluate the incidence of benzodiazepine overprescription as a cause of benzodiazepine overuse in nursing homes.

Physicians were asked to complete a multiple-choice questionnaire for patients receiving at least one benzodiazepine and to indicate the reason for the prescription. To control for social desirability bias, two fictitious cases were submitted to each physician. Overprescription was defined as a prescription for benzodiazepine that differed from the indications given in the product monograph.

Family physicians of patients living in three nursing homes in the Quebec City area were solicited by mail to take part in the survey.

Fifteen physicians treating 152 patients, whose average age was 82.1 years (range 50 to 100 years), agreed to take part in the study. It was found that 77.1% of the patients had been taking a benzodiazepine for more than a year. For 14.5% of the prescriptions, there was no official indication. The reasons most frequently cited for these prescriptions were that the physician was renewing a prescription given before he took charge of the patient, the patient's refusal to discontinue use of the medication, pressure from the nursing staff, and the fact that the patient was causing a disturbance. In 4% of the cases (6 answers), the physician acknowledged that there was no indication for prescribing a benzodiazepine.

This study shows that, in 14.5% of cases, overprescription could be a cause of benzodiazepine overuse in nursing homes.