Although benzodiazepine use among o...

Although benzodiazepine use among older community-dwelling characters is common, especially among women it has been associated with negative dependence of cause and effects including fall risk, depression, hip fractures, and cognitive decline. Measurement of physical function using performance-based measures is a possible way of detecting functional impairment before disability is observ In general, performance-based measures are highly predictive of after disability. Gray and colleagues prospectively studied the consequence of benzodiazepine use on the change in physical performance through a four-year period in community-dwelling, older women

Data were aggregateed as part of the Established Populations for Epidemiologic Studies of the somewhat old (EPESE) study. The sample for this analysis was 885 women 70 years and older (too not many men were taking benzodiazepines to include them in the study) The authors gathered data on baseline benzodiazepine use, dosage, indication, and duration of use. Physical performance measures included balance, walking spe and time to rise from a chair five times. Statistical analysis evaluated whether participants experienced decline, improvement, or no change with benzodiazepine use.

Of the 885 women participating, 90 (102 percent) reported benzodiazepine use at baseline. These women were more likely to report repose difficulty, nervousness, depressed mood, and decreased mobility and activities of daily living than nonusers. Benzodiazepine use was associated significantly with greater decline in performance during follow-up than nonuse in all three physical performance measures. Physical performance of long-term users (more than three years before baseline) declined significantly more than that of fresh users and past users. latter users showed greater decline than nonusers, admitting this difference was not significant, and past users had no decline. A dosage rejoinder was noted in benzodiazepine users, with a greater decline noted in women taking higher-than-recommended dosages, if it were not that not in women taking the minimum dosage or lower.

Benzodiazepine users were 264 times more likely than nonusers to have a significant decline in physical performance from one side of to the other four years, an association that persisted in women without disability at baseline.

This subject of attention provides evidence that benzodiazepine use in older women increases the risk for decline in physical performance--even in those without antecedent physical disability--particularly with higher-than-recommended dosages and in extent duration of use. The authors were able to command for enough confounding factors, particularly differences in indication for benzodiazepine use, to propose that decline in physical function arises from benzodiazepine use rather than vice versa. The decline in physical function may be mediated from such benzodiazepine effects as sedation and muscle relaxation.

CAROLINE WELLBERY, MD

Gray SL et al. Benzodiazepine use and physical performance in community-dwelling older women J Am Geriatr Soc November 2003;51:1563-70

COPYRIGHT 2004 American Academy of Family Physicians

COPYRIGHT 2004 Gale Group