ABSTRACT
Objectives
To systematically examine the prevalence of, and factors associated with, benzodiazepine, Z-drug and melatonin use in Australian residential aged care facilities (RACFs).
Methods
MEDLINE, Embase, CINAHL, PsycINFO, Scopus and International Pharmaceutical Abstracts were searched from January 2000 to February 2025 for studies reporting benzodiazepine, Z-drug and/or melatonin prevalence in Australian RACFs. Overall, regular and pro re nata (PRN) medication use was considered. Screening, data extraction and quality assessment were performed independently by two authors. The primary outcome was overall prevalence (regular and PRN) of benzodiazepines, Z-drugs and/or melatonin. Secondary outcomes included regular prevalence, PRN prevalence and medication class prevalence.
Results
Fifty-two studies (n = 658,585 residents) were included. Overall prevalence of benzodiazepines and/or Z-drugs was 33% (95% confidence interval [CI]: 30.4%–34.7%, 30 studies) when assessed over periods from point prevalence to one-year prevalence. Prevalence was highest when assessed using prescribing (35%) rather than dispensing (32%) or administration (28%) data. Findings were similar when limited to studies published in the last 10 years (31%), studies of 100 or more residents (32%) and when excluding studies conducted in subsets of residents (33%). Benzodiazepine prevalence (35% [95% CI: 32.5%–36.9%], 24 studies) was higher than Z-drug prevalence (0.4% [95% CI: 0.1%–1.1%], three studies). No published studies reported melatonin prevalence, and unpublished regular prevalence ranged 1%–9% (four studies).
Conclusions
One in three Australian residents in RACFs use benzodiazepines and/or Z-drugs. Targeted interventions are needed to ensure their use is consistent with evidence-based practice and residents’ clinical needs.