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Table 2 Factors influencing regular use of BZDs/Z-drugs, regular use of BZDs only, and regular use of Z-drugs only in the studied sample – results from the multiple logistic regression models

From: The prevalence and prescribing patterns of benzodiazepines and Z-drugs in older nursing home residents in different European countries and Israel: retrospective results from the EU SHELTER study

Factors influencing regular use of drug groups BZDs/Z-drugs   BZDs only   Z-drugs only
  Adjusted
OR (95% CI) g
p value   Adjusted
OR (95% CI) g
p value   Adjusted
OR (95% CI) g
p value
Age 0.993
(0.985–1.002)
0.139   0.990
(0.980–0.999)
0.029   1.001
(0.986–1.017)
0.858
Gender
 Male – reference 1.000    1.000    1.000  
 Female 1.063
(0.885–1.277)
0.513   1.061
(0.870–1.295)
0.558   1.073
(0.783–1.471)
0.661
Countries ordered by increasing prevalence of regular use of BZDs/Z-drugs Countries ordered by increasing prevalence of regular use of BZDs only Countries ordered by increasing prevalence of regular use of Z-drug only
Germany – ref. 1.000   England – ref. 1.000   Italy – ref. 1.000  
England 1.532
(1.070–2.193)
0.020 Germany 0.971
(0.560–1.503)
0.731 Finland 1.311
(0.487–3.527)
0.592
The Czech Republic 1.509
(1.064–2.140)
0.021 The Czech Republic 1.857
(1.192–2.894)
0.006 The Netherlands 1.093
(0.415–2.880)
0.857
Finland 1.888
(1.324–2.691)
< 0.001 Finland 3.298
(2.146–5.068)
< 0.001 The Czech Republic 3.662
(1.570–8.542)
0.003
Italy 2.631
(1.857–3.727)
< 0.001 France 3.655
(2.226–6.002)
< 0.001 Germany 3.809
(1.655–8.769)
0.002
The Netherlands 2.424
(1.738–3.381)
< 0.001 Italy 4.368
(2.864–6.622)
< 0.001 Israel 5.620
(2.478–12.744)
< 0.001
France 5.250
(3.473–7.936)
< 0.001 The Netherlands 4.008
(2.700–6.164)
< 0.001 England 7.727
(3.428–17.420)
< 0.001
Israel 6.660
(4.823–9.198)
< 0.001 Israel 9.715
(6.501–14.517)
< 0.001 France 20.953
(8.970–48.940)
< 0.001
CPSa 0.974
(0.908–1.044)
0.459   0.953
(0.883–1.030)
0.224   0.998
(0.892–1.115)
0.965
ADLHb 0.992
(0.981–1.003)
0.151   0.991
(0.979–1.005)
0.131   0.993
(0.976–1.012)
0.479
Pain scalec 1.113
(1.004–1.234)
0.041   1.119
(1.000–1.252)
0.050   1.095
(0.926–1.294)
0.290
CAP Deliriumd 0.992
(0.897–1.097)
0.876   1.012
(0.910–1.125)
0.830   0.884
(0.715–1.092)
0.253
Depression scalee 1.052
(1.020–1.085)
0.001   1.064
(1.030–1.100)
< 0.001   1.012
(0.960–1.067)
0.659
Communication scalef 0.941
(0.898–0.986)
0.010   0.955
(0.907–1.005)
0.077   0.930
(0.861–1.006)
0.069
Anxietyh
 Not present – reference 1.000    1.000    1.000  
 Diagnosis present 1.171
(0.608–2.252)
0.637   1.274
(0.639–2.540)
0.491   1.162
(0.407–3.323)
0.779
 Diagnosis present, treated 1.887
(1.382–2.578)
< 0.001   2.320
(1.688–3.187)
< 0.001   0.584
(0.316–1.078)
0.085
 Diagnosis present, monitored 0.820
(0.525–1.280)
0.382   0.792
(0.492–1.275)
0.337   0.957
(0.423–2.167)
0.917
Difficulty falling asleep
 Not present – reference 1.000    1.000    1.000  
 Diagnosis present in medical record, problem not exhibited 2.687
(2.098–3.443)
< 0.001   2.392
(1.837–3.115)
< 0.001   2.767
(1.859–4.119)
< 0.001
 Exhibited 1 of 3 days 1.953
(1.315–2.901)
< 0.001   1.501
(0.977–2.306)
0.063   3.052
(1.647–5.654)
< 0.001
 Exhibited 2 of 3 days 1.777
(1.118–2.824)
0.015   1.659
(1.007–2.731)
0.047   1.395
(0.578–3.370)
0.459
 Exhibited daily of 3 days 3.274
(2.481–4.320)
< 0.001   2.426
(1.797–3.275)
< 0.001   3.526
(2.373–5.238)
< 0.001
  1. Results in bold indicate statistically significant results
  2. a CPS– Cognitive Performance Scale [26] was used to access cognitive status. It includes five items: cognitive skills for daily decision making, short-term memory problems, procedural memory problems, making self-understood, and eating ability. Scores of CPS items range from 0 (intact) to 6 (very severe cognitive impairment), and any score ≥ 2 indicates clinically significant cognitive impairment (from mild to very severe stages)
  3. b ADLH scale –Activities of Daily Living Hierarchy scale [25] comprises 7 items: personal hygiene, dressing upper body, dressing lower body, locomotion, toilet use, bed mobility, eating. Each item is scored from 1 = requires supervision to 4 = total dependence. The scale ranges from 0 to 28, with higher scores reflecting greater level of dependency and difficulties in performing activities
  4. c Pain scale [28] - summarizes the reported presence and intensity of pain. It comprises two items: pain symptoms-frequency and pain symptoms-intensity of highest level of pain present. The scores range from 0 = no pain to 4 = daily excruciating pain
  5. d CAP Delirium [30] - this scale comprises 4 items: easily distracted, disorganized speech, mental function varies over day, change in decision making. The scale ranges from 0 to 4, with higher values indication increase likelihood of delirium
  6. e Depression scale [27] - is based on the self-reported mood items and indicates the presence of depressed mood and anxiety. It consists of 3 self-reported mood items, while each question can be scored from 0 to 2 with the maximum overall score of 6. The score of this scale range from 0 = no symptoms of depression to 6 = all symptoms present in last 3 days/24 h: high likelihood of depression
  7. f Communication scale [29] – consists of two items: making self-understood (expression) and ability to understand others (comprehension), while not taking directly into consideration hearing and visual impairment. It is primarily focused on dysphasia and similar syndromes. The scores range from 0 = intact to 8 = very severe impairment
  8. g Adjusted for all factors in univariate logistic regression: age, gender, functional and cognitive status, anxiety, insomnia, depression, delirium, pain, and communication problems
  9. h “Diagnosis present” – recorded when diagnosis confirmed as diagnosed clinical condition in medical charts; “Diagnosis present, treated” – resident’s diagnosis is being treated by active treatment (incl. Drug therapy, therapeutic rehabilitation services, other medical or skilled nursing interventions); “Diagnosis present, monitored” – resident’s diagnosis is being only monitored (e.g., by laboratory tests, vital signs, etc.) but no active treatment is provided