Progressive trends in the prevalence of benzodiazepine prescribing in older people in Ontario, Canada

OBJECTIVES: The extensive use of benzodiazepines has been a concern of heal thcare providers and policy makers in Canada and around the world. The purp ose of this study was to examine temporal trends in benzodiazepine prescrip tions dispensed in older people from 1993-1998. DESIGN: Retrospective population-based cross-sectional study using administ rative databases. SETTING: Ontario, Canada. PARTICIPANTS: The over 1 million residents of Ontario age 65 and older cove red by the provincial universal drug benefit program. MEASUREMENTS: The main outcome measures were the prevalence, overall and wi th respect to age and gender, of benzodiazepine prescriptions dispensed and the ratio of the number of people to whom short- versus long-acting benzod iazepine prescriptions were dispensed in each study year. The annual rates of switching to other psychotropic agents were examined for those patients that discontinued filling benzodiazepine prescriptions. RESULTS: The annual prevalence of benzodiazepine prescriptions dispensed de creased consistently over time (25.1% in 1993 to 22.5% in 1998; P < .001). Benzodiazepine dispensing prevalence increased with increasing age (approxi mately 20% of those age 65 to 69 to approximately 30% of those age greater than or equal to 85; P < .001) and more females than males received the med ication (relative risk = 1.50, 95% confidence interval = 1.49-1.51). The ra tio of short- to long-acting benzodiazepine prescriptions filled increased over time (3.6 in 1993 to 5.8 in 1998; P < .001), in line with guideline re commendations. Rates of switching to antidepressants increased over time (8 .5% in 1993 to 10.2% in 1998; P < .001), whereas switching to barbiturates was consistently low (0.12%; P = .403). CONCLUSION: The prevalence of benzodiazepine therapy for older people in On tario has steadily declined between 1993 and 1998. There is a trend of disp ensing relatively more short-acting than long-acting benzodiazepines and of replacing benzodiazepines with antidepressants in older people without a r emarkable increase in barbiturate consumption. These findings suggest that, without undue regulation, physicians are making progress in the prescribin g of benzodiazepine therapy on the basis of current knowledge available.