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
| 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 | ||
Results in bold indicate statistically significant results
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)
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
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
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
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
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
g Adjusted for all factors in univariate logistic regression: age, gender, functional and cognitive status, anxiety, insomnia, depression, delirium, pain, and communication problems
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