Table 1 Characteristics of patients with dementia prescribed Z-drugs and benzodiazepines and comparison cohorts
|  | Z-drug (n = 3532) | Sleep disturbance, no sedative-hypnotic (n = 1833) | No Z-drug, proximal GP consultation (n = 10,214) | Benzodiazepine (n = 5172) | No benzodiazepine, proximal GP consultation (n = 15,174) | |||||
|---|---|---|---|---|---|---|---|---|---|---|
Characteristic | n | % | n | % | n | % | n | % | n | % |
Women | 2087 | 59% | 1145 | 62% | 6074 | 59% | 3222 | 62% | 9491 | 63% |
Age, yearsa | 82.9 | 7.7 | 83.1 | 7.1 | 83.1 | 7.5 | 82.5 | 7.8 | 82.6 | 7.8 |
White ethnicityb | 3072 | 87% | 1539 | 84% | 8816 | 86% | 4470 | 86% | 13,042 | 86% |
Care homeb | 892 | 25% | 434 | 24% | 2108 | 21% | 1509 | 29% | 2979 | 20% |
Lives aloneb | 760 | 22% | 545 | 30% | 2848 | 28% | 993 | 19% | 4785 | 32% |
GP practice area IMD quintilea | 3.2 | 1.4 | 3.4 | 1.4 | 3.1 | 1.4 | 3.2 | 1.4 | 3.1 | 1.4 |
Current smokerb | 312 | 9% | 142 | 8% | 722 | 7% | 355 | 7% | 1124 | 7% |
Ex-smokerb | 765 | 22% | 428 | 23% | 2226 | 22% | 1163 | 22% | 3322 | 22% |
Alcohol drinkerb | 715 | 20% | 489 | 27% | 2142 | 21% | 1127 | 22% | 3297 | 22% |
Body mass indexa,b | 24.9 | 4.9 | 24.5 | 4.6 | 24.9 | 4.8 | 24.5 | 4.8 | 24.8 | 4.9 |
Systolic blood pressurea,b | 133.5 | 19.0 | 133.9 | 18.8 | 134.3 | 19.1 | 133.6 | 18.9 | 134.5 | 18.8 |
Dementia | ||||||||||
 Months since dementia diagnosisc | 11.4 | 3.6–26.2 | 11.0 | 3.8–24.1 | 13.5 | 5.2–27.4 | 15.6 | 5.1–32.4 | 10.3 | 3.7–22.0 |
 Dementia subtype | ||||||||||
 Alzheimer’s disease | 1355 | 38% | 746 | 41% | 4224 | 41% | 2140 | 41% | 6612 | 44% |
 Vascular dementia | 940 | 27% | 487 | 27% | 2773 | 27% | 1375 | 27% | 4046 | 27% |
 Other/mixed dementia | 409 | 12% | 192 | 10% | 1013 | 10% | 600 | 12% | 1377 | 9% |
 Unspecified dementia | 828 | 23% | 403 | 22% | 2184 | 21% | 1057 | 20% | 3139 | 21% |
 Agitation/psychosis history | 619 | 18% | 409 | 22% | 1261 | 12% | 1363 | 26% | 1341 | 9% |
 End of life care | 197 | 6% | 77 | 4% | 564 | 6% | 416 | 8% | 726 | 5% |
Sleep disturbance | ||||||||||
 Sleep disturbance pre-dementia | 825 | 23% | 615 | 34% | 1982 | 19% | 1064 | 21% | 2918 | 19% |
 History of benzodiazepine use | 869 | 25% | 222 | 12% | 1376 | 13% | 982 | 19% | 2009 | 13% |
 History of Z-drug use | 304 | 9% | 113 | 6% | 597 | 6% | 481 | 9% | 852 | 6% |
Medical history in the past year | ||||||||||
 Falls | 1003 | 28% | 542 | 30% | 2165 | 21% | 1241 | 24% | 3359 | 22% |
 Fractures | 360 | 10% | 131 | 7% | 657 | 6% | 409 | 8% | 1071 | 7% |
 Dizziness/unsteadiness | 214 | 6% | 127 | 7% | 652 | 6% | 294 | 6% | 817 | 5% |
 Faints/syncope | 184 | 5% | 120 | 7% | 533 | 5% | 357 | 7% | 712 | 5% |
 Urinary tract infection/acute LRTI | 928 | 26% | 423 | 23% | 2054 | 20% | 1242 | 24% | 3114 | 21% |
 Influenza vaccination | 2480 | 70% | 1340 | 73% | 7747 | 76% | 3739 | 72% | 11,350 | 75% |
 Pneumonia vaccination | 166 | 5% | 103 | 6% | 506 | 5% | 234 | 5% | 773 | 5% |
 Physician consultationsa | 12.5 | 10.3 | 11.2 | 9.4 | 14.9 | 12.7 | 12.9 | 10.7 | 13.7 | 12.0 |
 Hospital admissionsa | 1.3 | 3.0 | 1.0 | 2.2 | 0.9 | 1.6 | 1.1 | 1.9 | 0.9 | 2.3 |
Comorbidities | ||||||||||
 Depression | 894 | 25% | 493 | 27% | 2633 | 26% | 1512 | 29% | 3723 | 25% |
 Depression symptoms | 692 | 20% | 368 | 20% | 1898 | 19% | 1175 | 23% | 2804 | 18% |
 Anxiety | 576 | 16% | 311 | 17% | 1648 | 16% | 1204 | 23% | 2451 | 16% |
 Anxiety symptoms | 446 | 13% | 261 | 14% | 1181 | 12% | 877 | 17% | 1751 | 12% |
 Parkinson’s disease | 208 | 6% | 109 | 6% | 530 | 5% | 290 | 6% | 723 | 5% |
 Urinary incontinence | 520 | 15% | 465 | 25% | 1640 | 16% | 841 | 16% | 2273 | 15% |
 Benign prostatic hyperplasia | 361 | 10% | 175 | 10% | 1075 | 11% | 487 | 9% | 1474 | 10% |
 Asthma | 366 | 10% | 165 | 9% | 1056 | 10% | 517 | 10% | 1590 | 10% |
 Cancer | 743 | 21% | 313 | 17% | 2114 | 21% | 1002 | 19% | 3074 | 20% |
 COPD | 266 | 8% | 147 | 8% | 782 | 8% | 369 | 7% | 1209 | 8% |
 Osteoporosis | 417 | 12% | 215 | 12% | 1224 | 12% | 581 | 11% | 1885 | 12% |
 Other muscleroskeletal conditions | 448 | 13% | 248 | 14% | 1395 | 14% | 664 | 13% | 2036 | 13% |
 Osteoarthritis/rheumatoid arthritis | 1426 | 40% | 756 | 41% | 3980 | 39% | 2063 | 40% | 5906 | 39% |
 Other joint conditions | 2901 | 82% | 1537 | 84% | 8463 | 83% | 4293 | 83% | 12,615 | 83% |
 Headache/migraine | 720 | 20% | 363 | 20% | 2020 | 20% | 1101 | 21% | 2955 | 19% |
 Back/neck pain | 1959 | 55% | 1009 | 55% | 5640 | 55% | 2910 | 56% | 8380 | 55% |
 Age-related macular degeneration | 189 | 5% | 115 | 6% | 648 | 6% | 348 | 7% | 923 | 6% |
 Cataract | 992 | 28% | 547 | 30% | 2940 | 29% | 1400 | 27% | 4284 | 28% |
 Glaucoma | 356 | 10% | 186 | 10% | 1011 | 10% | 445 | 9% | 1459 | 10% |
 Retinal disorder | 295 | 8% | 138 | 8% | 944 | 9% | 415 | 8% | 1390 | 9% |
 Diabetes | 531 | 15% | 245 | 13% | 1712 | 17% | 718 | 14% | 2483 | 16% |
 Hyperlipidaemia | 470 | 13% | 269 | 15% | 1443 | 14% | 754 | 15% | 2152 | 14% |
 Hypertension | 1822 | 52% | 1006 | 55% | 5736 | 56% | 2762 | 53% | 8521 | 56% |
 Stroke/transient ischaemic attack | 783 | 22% | 397 | 22% | 2177 | 21% | 1091 | 21% | 3022 | 20% |
 Myocardial infarction | 310 | 9% | 172 | 9% | 909 | 9% | 433 | 8% | 1307 | 9% |
 Heart failure | 314 | 9% | 182 | 10% | 988 | 10% | 444 | 9% | 1350 | 9% |
 Atrial fibrillation | 528 | 15% | 260 | 14% | 1666 | 16% | 775 | 15% | 2365 | 16% |
 Angina | 532 | 15% | 308 | 17% | 1646 | 16% | 811 | 16% | 2263 | 15% |
 Venous thromboembolism | 236 | 7% | 123 | 7% | 737 | 7% | 341 | 7% | 1029 | 7% |
Prescriptions in the last 90 days | ||||||||||
 Anticholinesterase/memantine | 850 | 24% | 385 | 21% | 2417 | 24% | 1237 | 24% | 3662 | 24% |
 Antipsychotic | 811 | 23% | 371 | 20% | 1586 | 16% | 1125 | 22% | 851 | 6% |
 SSRI antidepressant | 763 | 22% | 352 | 19% | 1855 | 18% | 1174 | 23% | 2616 | 17% |
 Tricyclic antidepressant | 363 | 10% | 192 | 10% | 835 | 8% | 596 | 12% | 1748 | 12% |
 Other antidepressant | 294 | 8% | 153 | 8% | 575 | 6% | 483 | 9% | 771 | 5% |
 Antiepileptic | 241 | 7% | 110 | 6% | 610 | 6% | 424 | 8% | 825 | 5% |
 Analgesic | 1730 | 49% | 808 | 44% | 4107 | 40% | 2338 | 45% | 5805 | 38% |
 Inhaled corticosteroid | 191 | 5% | 96 | 5% | 507 | 5% | 196 | 4% | 742 | 5% |
 Lipid regulating medication | 1217 | 34% | 630 | 34% | 3492 | 34% | 1644 | 32% | 5324 | 35% |
 Diuretic | 1188 | 34% | 633 | 35% | 3322 | 33% | 1456 | 28% | 4779 | 31% |
 Beta blocker | 645 | 18% | 328 | 18% | 1907 | 19% | 850 | 16% | 2771 | 18% |
 ACE inhibitor | 709 | 20% | 379 | 21% | 2222 | 22% | 991 | 19% | 3357 | 22% |
 Angiotensin II receptor antagonist | 235 | 7% | 124 | 7% | 724 | 7% | 330 | 6% | 1123 | 7% |
 Calcium channel blocker | 643 | 18% | 339 | 18% | 1947 | 19% | 849 | 16% | 2980 | 20% |
 Anticoagulant | 204 | 6% | 103 | 6% | 739 | 7% | 295 | 6% | 1056 | 7% |
 Antiplatelet | 1603 | 45% | 878 | 48% | 4390 | 43% | 2171 | 42% | 6439 | 42% |
 Cardiac glycoside | 281 | 8% | 155 | 8% | 768 | 8% | 345 | 7% | 1032 | 7% |
 NSAID | 352 | 10% | 156 | 9% | 815 | 8% | 468 | 9% | 1206 | 8% |
 Bisphosphonate | 375 | 11% | 194 | 11% | 1074 | 11% | 477 | 9% | 1618 | 11% |
 Calcium/vitamin D | 677 | 19% | 377 | 21% | 1854 | 18% | 888 | 17% | 2754 | 18% |
 Antibiotic (in last 30 days) | 1098 | 31% | 567 | 31% | 2590 | 25% | 1370 | 26% | 3640 | 24% |