The percentage of persons 67 years of age and older who were dispensed benzodiazepines and achieved a 20% decrease or greater in benzodiazepine dose (diazepam milligram equivalent [DME] dose) during the measurement period.<\/p>\n
The deprescribing measure is complementary to the Use of High-Risk Medications in Older Adults (DAE) measure. The DAE measure assesses potentially inappropriate use of benzodiazepines in the Medicare population by measuring \u201cany dispensing\u201d of benzodiazepines (defined as at least two dispensing events) in the measurement year. The deprescribing measure provides a metric to support safe transition off of benzodiazepines for those members referenced in DAE who are currently and routinely using them.<\/p>\n
Benzodiazepines have class-level warnings for users that include dependence and withdrawal reactions, such as seizures, central nervous system depression and impaired performance1<\/a><\/sup>. Benzodiazepines induce sedation, which causes drowsiness, delayed reaction times and impaired balance2<\/a><\/sup>. This can result in increased risk of hip fractures, falls and fall-related injuries in older adults prescribed short- and long-acting benzodiazepines2<\/a> 3<\/a> 4<\/a> 5<\/a> 6<\/a><\/sup>. Although benzodiazepines are indicated for short-term treatment of generalized anxiety disorder7<\/a> 8<\/a> 9<\/a><\/sup> there is risk of continued long-term use in older adults, as many chronic users are rarely encouraged to discontinue the medication10<\/a> 11<\/a><\/sup>. Studies have found that long-term use of benzodiazepines in older adults is also associated with increased risk of dementia12<\/a> 13<\/a> 14<\/a> 15<\/a><\/sup>. Other harms related to benzodiazepine use include impaired cognition, loss of physical function, depressed mood and suicidal thoughts16<\/a> 17<\/a> 18<\/a><\/sup>.<\/p>\n Despite the risks associated with benzodiazepines, these medications are inappropriately prescribed and overused in the older adult population. Older adults are prescribed benzodiazepines at the highest rate and are most at risk of adverse events among all U.S. adults19<\/a> 20<\/a><\/sup>. In 2015, CMS reported that 17.6% of all Medicare Part D enrollees were dispensed benzodiazepines21<\/a><\/sup>. After the expansion of Medicare coverage for prescription benzodiazepines in 2013, the prevalence of benzodiazepine use increased20<\/a> 22<\/a><\/sup>. This increase in prevalence may be associated with both increases in fall-related injuries and medication poisoning among older adults20<\/a><\/sup>.<\/p>\n Use of benzodiazepines is associated with higher health care service use and costs. A recent study estimates that about 212,770 ED visits involving adverse medication-related events in 2016 were related to benzodiazepine use, representing approximately 10% of all ED visits attributed to adverse medication-related events23<\/a><\/sup>. Specifically among older adults, it estimated that half of the ED visits involved non-therapeutic use of benzodiazepines (i.e., taking the drug inappropriately or not as prescribed)23<\/a><\/sup>. Among all potentially inappropriate medications, benzodiazepines were identified as the third largest medication class contributing to total medication costs of older adults living in residential care, following proton-pump inhibitors and antipsychotics24<\/a><\/sup>.<\/p>\n Given the risks and high utilization, multiple sources of clinical or other guidance recommend against benzodiazepine use in older adults. The 2023 American Geriatrics Society (AGS) Beers Criteria\u00ae for Potentially Inappropriate Medication (PIM) Use in Older Adults recommend avoiding benzodiazepines\u2014all short-, intermediate-, and long-acting forms\u2014for all older adults due to risk of cognitive impairment, delirium, falls, fractures and motor vehicle crashes25<\/a><\/sup>. The Screening Tool of Older Persons\u2019 Prescriptions (STOPP) CNS criteria D5 recommends that benzodiazepines should not be taken for \u22654 weeks if there is no indication for longer treatment, due to risk of prolonged sedation, confusion, impaired balance, falls and traffic accidents. The guideline continues, \u201call benzodiazepines should be withdrawn gradually if taken for >2 weeks, as there is a risk of causing a benzodiazepine withdrawal syndrome if stopped abruptly26<\/a><\/sup>.\u201d<\/p>\n It is important to reduce benzodiazepine use among current users through appropriate \u201cdeprescribing,\u201d which is the process of tapering, with the goal of stopping drugs, to improve patient outcomes. Benzodiazepines should be discontinued at a rate that is appropriate and safe for older adults. Several deprescribing guidelines for older adults (aged 65 and older) recommend starting with a larger taper amount (between 20% and 25%), holding at that dose for 2\u20134 weeks, then tapering by a lower amount (e.g., by 5%\u201312.5%). Overall, there is agreement that a slower taper is considered better to minimize withdrawal symptoms such as insomnia, anxiety, restlessness and seizures27<\/a> 28<\/a> 29<\/a><\/sup>. Immediate discontinuation of benzodiazepines is not recommended30<\/a> 31<\/a> 32<\/a><\/sup>; therefore, there is a need for a tapering measure to balance measures incentivizing no benzodiazepine use and to provide a path to safe discontinuation of the drug. With a deprescribing measure, there is opportunity to promote harm reduction by assessing progress in appropriately reducing benzodiazepine use in the older adult population.<\/p>\n <\/p>\n","protected":false},"excerpt":{"rendered":" The percentage of persons 67 years of age and older who were dispensed benzodiazepines and achieved a 20% decrease or greater in benzodiazepine dose (diazepam milligram equivalent [DME] dose) during the measurement period. Why It Matters? The deprescribing measure is complementary to the Use of High-Risk Medications in Older Adults (DAE) measure. The DAE measure […]<\/p>\n","protected":false},"author":45,"featured_media":0,"parent":733,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page.php","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-41105","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"\nHistorical Results \u2013 National Averages<\/h2>\n