Prevalence and Severity of Cognitive Impairment Among Older Adults Using Benzodiazepines in Primary Care: Association with Duration of Use and Prescribing Pattern in Mexico

Background: Benzodiazepines are widely prescribed to older adults in primary care despite concerns regarding their potential cognitive adverse outcomes. Evidence on the association between benzodiazepine use and cognitive impairment remains inconsistent and is limited in middle-income countries, particularly in routine primary care settings. Objectives: To evaluate the association between benzodiazepine use and cognitive impairment among older adults in a primary care hospital in Mexico and to explore clinical factors associated with benzodiazepine prescribing patterns. Methods: A cross-sectional analytical study was conducted using non-probabilistic convenience consecutive sampling in a sample of 228 in adults aged ≥60 years attending a primary care hospital in Irapuato, Mexico, during 2025. Cognitive status was assessed using the Mini-Mental State Examination (MMSE) and classified as normal cognition, mild/moderate cognitive impairment, or major cognitive impairment. Benzodiazepine exposure was identified through pharmacy records and categorized by duration of exposure (<3 years, 3–6 years, and >6 years). Sociodemographic variables were collected. Associations were evaluated using chi-square tests, and crude logistic regression models were used to estimate odds ratios (ORs) with 95% confidence intervals (CIs). An additional exploratory analysis assessed clinical factors associated with benzodiazepine type using a dichotomized outcome to ensure model stability. Results: A total of 228 older adults with documented benzodiazepine use were included. The sample represents the complete population of eligible benzodiazepine users during the study period. Cognitive impairment was identified in 61.8% of participants. Longer duration of benzodiazepine use was significantly associated with worse cognitive status (χ2 = 25.81; p < 0.001), with the highest proportion of major impairment observed in individuals with more than six years of use. In exploratory analyses, benzodiazepine prescribing patterns were significantly associated with sleep disorders (χ2 = 11.56; p = 0.009), polypharmacy (χ2 = 10.28; p = 0.016), and MMSE category (χ2 = 13.87; p = 0.031). In adjusted models, polypharmacy was associated with increased odds of receiving the most frequently prescribed benzodiazepine (OR 2.37; 95% CI 1.27–4.41; p = 0.007), while sleep disorders (OR 2.10; 95% CI 1.10–3.90; p = 0.009) and cognitive status (OR 1.85; 95% CI 1.05–3.20; p = 0.031) also showed significant associations. No comparisons with non-users were performed due to lack of comparable cognitive assessment; however, this comparison should be interpreted cautiously due to differences in assessment methods between groups. Conclusions: Among benzodiazepine users in primary care, longer duration of exposure was associated with worse cognitive status. Additionally, prescribing patterns were influenced by clinical factors such as polypharmacy, sleep disorders, and cognitive status, suggesting a predominantly clinically driven approach. These findings highlight benzodiazepine use as an important marker of cognitive vulnerability and underscore the need for careful prescribing, regular medication review, and deprescribing strategies in older adults.