Patterns of benzodiazepine use and risk of injury in the elderly
Notice bibliographique
Résumé
Background. Benzodiazepines are sedative-hypnotic medications frequently prescribed in elderly patients for several clinical indications. An association with increased risk for falls has been reported but there is continued debate regarding which specific benzodiazepines are associated with this risk. Objectives. To estimate the risk of injuries from falls associated with benzodiazepine use in an elderly cohort taking into account patient characteristics and changes in patterns of use over time. Methods. Using information from provincial administrative health databases, 462,543 community-dwelling, 66 year old Quebec residents were screened for benzodiazepine use in 1989. Subjects who did not use benzodiazepines in 1989 were observed for the next five years to estimate incidence rates and evaluate patient characteristics associated with new use for thirteen benzodiazepines. Patterns of use for incident users were characterized in terms of duration, dose and frequency of switching or adding benzodiazepines. New methods were developed to model the past cumulative dose and duration of benzodiazepine exposure. The impact of benzodiazepine exposure on risk of injury was estimated using Cox proportional hazards analyses with time-dependent covariates to take into account changes in dose and patterns of use. Results. The overall incidence rate for benzodiazepines was 88.7 per 1,000 person-years, with higher rates in women (95.0) than men (81.8). Predictors of incident use were different in individual products and there were systematic differences between users and non-users. Use of anti-depressants in 1989 was the strongest predictor for incident benzodiazepine use (HR 1.45 to 3.07, p < 0.0001). The median duration for uninterrupted periods of use was 31 days (mean = 75.5 days, sd = 137.2). The mean dose was almost half the recommended maximum adult daily dose and only 8.6% of subjects exceeded the maximum. Older age at date of first prescription significantly increased the likelihood of increasing duration and dose overtime (OR = 1.02, p < 0.0001). All benzodiazepines except clonazeparn were significantly associated with an increased risk of injuries from falls (p < 0.05). The best predictive model for most benzodiazepines included a cumulative measure of duration and current dose. Conclusion. Benzodiazepines are associated with an increased risk of injuries from falls in elderly patients, however duration of exposure may be more critical than dose. Physiological dependence and withdrawal symptoms appear to play an important role in increasing the risk for many benzodiazepines.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».