Benzodiazepine use in the elderly: an indicator for inappropriately treated geriatric depression?

OBJECTIVE: To measure the prevalence of benzodiazepine (BZD) use and to explore associated demographic and clinical variables of BZD use within a cohort of 75-year- old inhabitants of an urban district of Vienna. METHODS: This is a prospective, interdisciplinary cohort study on aging. Our investigation is based on the first consecutive 500 subjects that completed the study protocol. Demographic and clinical characteristics, benzodiazepine and antidepressant use were documented using a standardized questionnaire. Affective status was assessed using the Hamilton Depression Rating Scale (HAMD), the Geriatric Depression Scale (GDS), and the Spielberger State-and Trait Anxiety Inventory subscales (STAI). RESULTS: Prevalence of BZD use was 13.8%. Compared to non-users, BZD users had significantly higher mean scores at the HAMD (p = 0.001), the GDS (p = 0.026), and the Spielberger State-and Trait Anxiety Inventory subscales (p = 0.003; p = 0.001). Depression was found in 12.0% (HAMD) and 17.8% when using a self-rating instrument (GDS). Less than one-third of depressed subjects were receiving antidepressants. Statistically equal numbers were using benzodiazepines. CONCLUSIONS: Inappropriate prescription of BZD is frequent in old age, probably indicating untreated depression in many cases. The implications of maltreated geriatric depression and the risks associated with benzodiazepine use highlight the medical and socioeconomic consequences of inappropriate BZD prescription.

Subjective memory complaints and objective memory impairment in the Vienna-Transdanube aging community.

OBJECTIVES: To help answer the question of whether subjective memory complaints are a useful feature in classification systems addressing early stages of Alzheimer's disease. DESIGN: A cross-sectional investigation in the context of a community-based cohort study. SETTING: Vienna, Transdanube-a geographically defined, urban, working-class area. PARTICIPANTS: Three hundred two nondemented 75-year-olds were examined with regard to subjective memory complaints and objective memory performance. The patients were divided into two groups with respect to subjective memory complaints and into two groups with respect to memory performance on the Fuld Object Memory Evaluation. MEASUREMENTS: The percentage of individuals with memory complaints who also had objective memory impairment and the percentage of individuals with objective memory impairment who also complained about their memory were measured. RESULTS: One-tenth (10.6%) (95% confidence interval (CI)=7.7-14.7) of community based sample of 75-year-old subjects complained about their memory. There was no difference between complainers and noncomplainers with regard to actual memory performance. Only 6.3% (95% CI=0.16-30.2) of memory-impaired subjects complained about their proven memory impairment. CONCLUSION: About 94% (95% CI=69.8-99.8) of memory-impaired individuals do not complain about memory problems. Subjective memory complaints may not be a useful feature in current diagnostic criteria of mild cognitive impairment.