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BRIEF REPORT |
Correspondence: Address correspondence to Richard Isralowitz, PhD, Department of Social Work, Ben Gurion University, Beer Sheva, Israel 84105. E-mail: Richard{at}bgu.ac.il
Abstract
Purpose: In this prospective study, we examine the reasons for benzodiazepine use among Russian-speaking elderly people in Israel, and we discuss issues related to immigrants. We provide information that can be applied to the improvement of age-related health and social services. Design and Methods: During a 6-month period, we interviewed late-life Russian-speaking immigrants in Israeli independent living facilities to determine benzodiazepine use among such individuals. Results: Among individuals interviewed, 69% reported use; 45% of those who used the substance did so daily. Respondents aged 80 and older were more likely than those aged younger than 80 to use benzodiazepines. More men (78%) than women (67%) reported use, but we found no significant difference in a comparison of gender status and pattern of drug use. Implications: Although other studies of drug use show that patterns of use differ significantly among older men and women, this research indicates that gender status does not appear to influence the pattern of, and reasons for, benzodiazepine use. Additional studies are needed in order for researchers to further understand the nature and extent of benzodiazepine use. Such information should be applied to the development of policies and services that will address the quality-of-life needs of individuals who use or misuse this drug and others like it.
Key Words: Benzodiazepine use • Gender differences • Israel • Russian-speaking immigrants
Among older people, the inappropriate use of benzodiazepines, like other psychotropic drugs (including alcohol), is a major public health problem that leads to mortality, morbidity, and related health costs (Moos, Brennan, Schutte, & Moos, 2004). Studies in the United States and Canada have documented that the level of potentially inappropriate medication use among nursing home residents may be as high as 40%, and it may be between 14% and 37% for elderly people in community-based care facilities (Use of Potentially Inappropriate Medications, 2005). Researchers have reported that approximately 35% of board-and-care facility older residents, who average 82 years of age, use at least one psychoactive agent (Spore, Mor, Hiris, Larrat, & Hawes, 1995).
Studies of immigrants show that many of these individuals experience a variety of emotional and cognitive adjustments and behavioral problems associated with acculturation in a new country (Isralowitz, Straussner, Vogt, & Chtenguelov, 2002; Straussner, 2002). Alcohol and drug use can emerge as a coping mechanism to mitigate the stresses that immigrants encounter in the host society (Cortes et al., 2003).
Russian-Speaking Immigrants in Israel
At the end of the 1980s, many elderly people left behind a familiar environment, language, culture, community, and social system to emigrate from the former Soviet Union to Israel, the United States, and other countries. Little is known, however, about psychotropic drug use among immigrants from the former Soviet Union (Isralowitz, Straussner, & Rosenblum, 2006; Isralowitz et al., 2002). At the end of 2001, there were about 130,200 Russian-speaking immigrants in Israel who were aged 65 years and older; they represented 15% of all immigrants and 20% of all elderly individuals in the country (JDC-Brookdale Institute, 2002). Our purpose in this prospective study of benzodiazepine use among Russian-speaking elderly people in Israel is to provide information that can be applied to improving age-related health and social services.
Methods
We focused on a sample of older people who immigrated to Israel after 1989. We told the directors of three independent living facilities in Beer Sheva, the major population center in the southern region of the country, about the study. They, in turn, informed the residents about the effort and requested consent to provide their names to a Russian-speaking research assistant, who, under the supervision of a physician working with older people, conducted the interviews. The assistant conducted the interviews on a voluntary and anonymous basis during a 6-month period in 2005 in the residents' apartments or the communal lounge. Not being at home or in the lounge for the interview was the main reason for exclusion. Those individuals who were interviewed were dementia free.
The study cohort consisted of 112 female and 32 male residents. The number of residents interviewed was 55% of the approximately 260 Russian-speaking people who lived in the independent living facilities. Approximately 80% of the residents of the independent living facilities were Russian; the remaining residents were from Ethiopia, Argentina, Morocco, Iraq, and Romania. We collected data in compliance with the human subject guidelines of the participating university research institute. We used a modified version of the CAGE instrument (Mayfield, McLeod, & Hall, 1974), which is easily administered and useful for identifying substance abuse problems (Hester & Miller, 1995; Lairson et al., 1992) for data collection. The instrument included questions to determine whether the respondent used the substance at all, or on a daily basis, and, if used, the reasons for its use. We found the data-collection instrument to be reliable (Cronbach's alpha, 
= 0.76).
Results
The median age of the elderly people interviewed was 80 years. Respondents who were 80 years of age and older were more likely than those younger than 80 to use benzodiazepines (
2 = 18.85; df = 1; p <.001). Benzodiazepine use was reported by 69% of the study group. More men (78%) than women (67%) reported use; among these men, 45% used the drug on a daily basis. We found no significant difference when we compared gender status and pattern of drug use.
All benzodiazepine users reported that they took the medication for insomnia, and 27% said that there were additional reasons for use, including stress and anxiety, sadness and loneliness, and acculturation difficulties such as Hebrew-language use and family loss. Table 1<--?1--> provides details about gender status and the major reasons for benzodiazepine use.
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The ability to generalize the findings of this prospective inquiry of late-life Russian-speaking immigrants and benzodiazepine use is limited because of the small study sample. Other limitations are the absence of a non-Russian-speaking immigrant group for comparison and a lack of information concerning the patterns of use and misuse, including dosage amount, frequency, duration, and adverse reactions to the drug.
This research indicates that gender status does not appear to influence the pattern of and reasons for benzodiazepine use. However, other studies of drug use, particularly those concerning alcohol, show that patterns of use differ significantly among older men and women (Adams, Barry, & Fleming, 1996; Graham et al., 1992; Moos et al., 2004). In the United States and Europe, male individuals outnumber female individuals in all age groups among people who have tried drugs (EMCDDA, 2002; Office of Applied Studies, 2004).
Fialová and colleagues (2005) have noted that the possible abuse of psychotropic drugs such as benzodiazepines among community-dwelling older adults in European countries appears to be a common problem, with variations reflective of country-specific drug policies, care provisions, and socioeconomic and health conditions, as well as other reasons such as adjustment to a new environment. In the present study, only 12% of the interviewed older adults attributed daily benzodiazepine use to acculturation difficulties, reporting, for example, that "it is difficult ... to get used to life in Israel .... I do not know Hebrew and all day I sit at home and watch TV in Russian ... bad news about events in Israel frightens me."
Service provider and client miscommunication, especially if it involves use of a foreign language, is another reason for possible improper drug use among elderly people. In a report on the prevention of drug abuse and misuse, Carlson (1994) pointed out that older adults often have sensory and cognitive deficits that make understanding medication instructions difficult. In addition, an older person may play a role in medication misuse by failing to report symptoms, underusing medications to avoid side effects or save money, or using them in combination with alcohol, which heightens the risk of adverse effects.
Finally, it is important to point out that Russian-speaking elderly people in Israel are not a homogeneous population; there appears to be variability in biological, psychological, social, and illness factors that may influence inappropriate drug use. This variability suggests that the management of age-related problems, including improper psychotropic drug use, will require specific tailoring of treatments and services (Patterson, Lacro, & Jeste, 1999). Additional studies are needed in order for researchers to further understand the nature and extent of benzodiazepine use. This includes the appropriateness of client problem diagnosis, treatment plan, and drugs being prescribed for late-life Russian-speaking immigrants, as well as other older people in the country. Such information should be applied to the development of policy and services that will address these individuals' quality-of-life needs.
Footnotes
1 Regional Alcohol and Drug Abuse Resources Center, Spitzer Department of Social Work, Ben Gurion University, Beer Sheva, Israel. 
Decision Editor: Linda S. Noelker, PhD
Received for publication December 29, 2005. Accepted for publication May 17, 2006.
References
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