Trajectories Associated With the Use and Deprescription of Benzodiazepines and Z ‐Drugs in a Network of Geriatric Outpatient Clinics

Purpose To determine the trajectories of benzodiazepine (BZD) and Z‐drug use among older adults ( n = 3590) followed in a network of geriatric outpatient clinics in Brazil. Methods This longitudinal study evaluated BZD and Z‐drug use over a 24‐month follow‐up period. The proportion of use at baseline and at the end of the study period was compared using the McNemar test. Two trajectories were considered: started using and stopped using . Comparisons between trajectories and independent variables were performed using Pearson's chi‐square test. Variables with p < 0.20 were eligible for multivariate analysis. Multivariate models were also used to identify factors associated with BZD or Z‐drug use at baseline and with trajectories of initiation and discontinuation. Odds ratios (OR) with 95% confidence intervals were estimated. Results A small but significant reduction in overall BZD or Z‐drug use was observed (17.4% to 16.0%; p = 0.007), with a marked decrease in isolated Z‐drug use (6.1% to 4.0%; p < 0.001). At baseline, use was associated with female sex (OR = 1.48; 95% CI 1.19–1.84), age 60–74 years (OR = 1.64; 95% CI 1.29–2.10), having ≥ 2 fall‐related conditions (OR = 2.53; 95% CI 1.94–3.31), higher frailty scores, and cognitive dysfunction (OR = 1.32; 95% CI 1.00–1.74). Initiation was associated with pharmacist consultations during follow‐up (OR = 5.01; 95% CI 2.88–8.71), depression (OR = 2.59; 95% CI 1.80–3.73), insomnia (OR = 1.97; 95% CI 1.19–3.25), and panic syndrome. Pharmacist consultation was also associated with discontinuation (OR = 0.34; 95% CI 0.15–0.76). Conclusions Clinical vulnerability and psychiatric conditions were associated with BZD or Z‐drug use and initiation, while pharmacist consultations were associated with both initiation and discontinuation trajectories.