Benzodiazepine Use and Physical Performance in Community-Dwelling Older Women

Authors

  • Shelly L. Gray PharmD, MS,

    1. From the *School of Pharmacy, University of Washington, Seattle, WashingtonDepartment of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North CarolinaCollege of Pharmacy, University of Minnesota, Minneapolis, Minnesota§Epidemiology and Demography Section, Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MarylandDepartment of Preventive Medicine and Environmental Health, University of Iowa, Iowa CityPhysical Activity and Health Branch, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GeorgiaDepartment of Epidemiology, University of Washington, Seattle, Washington**Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington.
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  • Brenda W. J. H. Penninx PhD,

    1. From the *School of Pharmacy, University of Washington, Seattle, WashingtonDepartment of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North CarolinaCollege of Pharmacy, University of Minnesota, Minneapolis, Minnesota§Epidemiology and Demography Section, Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MarylandDepartment of Preventive Medicine and Environmental Health, University of Iowa, Iowa CityPhysical Activity and Health Branch, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GeorgiaDepartment of Epidemiology, University of Washington, Seattle, Washington**Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington.
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  • David K. Blough PhD,

    1. From the *School of Pharmacy, University of Washington, Seattle, WashingtonDepartment of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North CarolinaCollege of Pharmacy, University of Minnesota, Minneapolis, Minnesota§Epidemiology and Demography Section, Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MarylandDepartment of Preventive Medicine and Environmental Health, University of Iowa, Iowa CityPhysical Activity and Health Branch, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GeorgiaDepartment of Epidemiology, University of Washington, Seattle, Washington**Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington.
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  • Margaret B. Artz PhD,

    1. From the *School of Pharmacy, University of Washington, Seattle, WashingtonDepartment of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North CarolinaCollege of Pharmacy, University of Minnesota, Minneapolis, Minnesota§Epidemiology and Demography Section, Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MarylandDepartment of Preventive Medicine and Environmental Health, University of Iowa, Iowa CityPhysical Activity and Health Branch, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GeorgiaDepartment of Epidemiology, University of Washington, Seattle, Washington**Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington.
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  • Jack M. Guralnik MD, PhD,

    1. From the *School of Pharmacy, University of Washington, Seattle, WashingtonDepartment of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North CarolinaCollege of Pharmacy, University of Minnesota, Minneapolis, Minnesota§Epidemiology and Demography Section, Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MarylandDepartment of Preventive Medicine and Environmental Health, University of Iowa, Iowa CityPhysical Activity and Health Branch, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GeorgiaDepartment of Epidemiology, University of Washington, Seattle, Washington**Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington.
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  • Robert B. Wallace MD,

    1. From the *School of Pharmacy, University of Washington, Seattle, WashingtonDepartment of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North CarolinaCollege of Pharmacy, University of Minnesota, Minneapolis, Minnesota§Epidemiology and Demography Section, Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MarylandDepartment of Preventive Medicine and Environmental Health, University of Iowa, Iowa CityPhysical Activity and Health Branch, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GeorgiaDepartment of Epidemiology, University of Washington, Seattle, Washington**Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington.
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  • Dave M. Buchner MD,

    1. From the *School of Pharmacy, University of Washington, Seattle, WashingtonDepartment of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North CarolinaCollege of Pharmacy, University of Minnesota, Minneapolis, Minnesota§Epidemiology and Demography Section, Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MarylandDepartment of Preventive Medicine and Environmental Health, University of Iowa, Iowa CityPhysical Activity and Health Branch, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GeorgiaDepartment of Epidemiology, University of Washington, Seattle, Washington**Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington.
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  • Andrea Z. LaCroix PhD

    1. From the *School of Pharmacy, University of Washington, Seattle, WashingtonDepartment of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North CarolinaCollege of Pharmacy, University of Minnesota, Minneapolis, Minnesota§Epidemiology and Demography Section, Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MarylandDepartment of Preventive Medicine and Environmental Health, University of Iowa, Iowa CityPhysical Activity and Health Branch, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GeorgiaDepartment of Epidemiology, University of Washington, Seattle, Washington**Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington.
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  • Financial support was provided by Grant K08AG00808-01 from the National Institute on Aging (Dr. Gray) and from the VFW Endowed Chair in Pharmacotherapy for the Elderly, College of Pharmacy, University of Minnesota (Dr. Artz).

Address correspondence to Dr. Shelly L. Gray, University of Washington, School of Pharmacy, Box 357630, Seattle, WA 98195. E-mail: slgray@u.washington.edu

Abstract

Objectives: To determine whether benzodiazepine use in older women increased the risk of decline in physical function.

Design: A four-year prospective cohort study.

Setting: The communities of Iowa and Washington counties, Iowa.

Participants: Eight hundred eighty-five women aged 70 and older who had completed physical performance tests in 1988 and 1992.

Measurements: Benzodiazepine use was determined during in-home interviews and classified by dose, duration, indication for use, and half-life. Physical performance tests included an assessment of standing balance, walking speed (8-foot distance), and repeated chair raises.

Results: Ninety (10.2%) reported benzodiazepine use at baseline. After adjustment for baseline physical performance score and potential confounders, benzodiazepine use was associated with a greater decline in physical performance over 4 years than nonuse (β=–1.16; standard error (SE)=0.25; P<.001). The use of higher-than-recommended dose was related to decline (β=–2.26; SE=0.47; P<.001), and use of lower doses was not (β=–0.53; SE=0.46; P=.246). Long-term use (≥3 years) was related to decline (β=–1.65; SE=0.34; P<.001), whereas recent and past use were not. Similar results were obtained when restricting the sample to those without disability at baseline.

Conclusion: This study provides evidence that older women who used benzodiazepines were at risk for decline in physical performance. Subgroup analyses indicated that risk was greater with use of higher-than-recommended doses or for long duration (≥3 years). These findings highlight the importance of using benzodiazepines at the lowest effective dose for a limited duration in older women.

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