Hazardous Benzodiazepine Regimens in the Elderly: Effects of Half-Life, Dosage, and Duration on Risk of Hip Fracture

Wang, Philip S.; Bohn, Rhonda L.; Glynn, Robert J.; Mogun, Helen; Avorn, Jerry

doi:10.1176/appi.ajp.158.6.892

Cited by 273 publications

(201 citation statements)

References 40 publications

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“…Telles Filho et al 8 e Alvarenga et al 12 descreveram o alto consumo de benzodiazepínicos por esse grupo de usuários e relacionaram o uso com as queixas de insônia. O uso de benzodiazepínicos em idosos, embora frequente, está relacionado a fraturas 13 , prejuízos cognitivos 14 e dependência 15 . A despeito desses desfechos e das recomendações das diretrizes que sugerem que benzodiazepínicos sejam utilizados por curtos espaços de tempo, muitos médicos não veem o uso desses fármacos como um problema de saúde pública 16 e consideram esses medicamentos soluções mais eficazes do que medidas não farmacológicas 17 .…”

Section: Resultsunclassified

A prescrição de benzodiazepínicos no Brasil: uma análise da literatura

Fiorelli

Assini²

2017

ABCS Health Sci.

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Benzodiazepínicos são medicamentos psicotrópicos de prescrição restrita e sujeitos a controle especial, conforme a Portaria nº 344, de 12 de maio de 1998. São utilizados como hipnóticos e sedativos, sendo bastante comuns na prática clínica. O uso prolongado destes fármacos pode causar dependência e por isso é necessário identificar seu perfil de prescrição. Este estudo busca revisar a literatura sobre os trabalhos que descreveram o uso de benzodiazepínicos no Brasil. Para isso, uma busca direta foi realizada em três bases de dados, Literatura LatinoAmericana e do Caribe em Ciências da Saúde (LILACS), PubMed e Scientific Eletronic Library Online (SciELO), utilizando os descritores prescrição/prescription, benzodiazepínicos/benzodiazepines, Brasil/ Brazil. Depois de aplicados os critérios de inclusão e exclusão, restaram 12 artigos, os quais foram analisados. A análise destes trabalhos mostrou que, no Brasil, os benzodiazepínicos são utilizados especialmente por mulheres com tendência ao aumento do uso com o avançar da idade. Desta maneira, conclui-se que permanece a necessidade de políticas públicas que busquem o uso racional destes fármacos.

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Section: Resultsunclassified

A prescrição de benzodiazepínicos no Brasil: uma análise da literatura

Fiorelli

Assini²

2017

ABCS Health Sci.

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“…In the current climate of major fiscal pressure on health resources, the overuse of PPIs becomes more relevant in terms of overall drug expenditure by governments globally. Inappropriate prescription of long-acting benzodiazepines in older patients has been highlighted repeatedly in the literature over the last 25 years, in particular given the link with falls and fracture risk and the difficulties with successful withdrawal [35][36][37]. Despite this, long-acting benzodiazepines continue to be initiated and repeatedly prescribed for older patients in primary and secondary care in Ireland and other countries [10,[12][13][14].…”

Section: Discussionmentioning

confidence: 99%

Potentially inappropriate prescribing in an Irish elderly population in primary care

Ryan¹,

O’Mahony

Kennedy³

et al. 2009

Brit J Clinical Pharma

255

256

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WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Potentially inappropriate prescribing in older people is a well‐documented problem and has been associated with adverse drug reactions and hospitalization.• Beers' criteria, Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) are screening tools that have been formulated to help physicians and pharmacists identify potentially inappropriate prescribing and potential prescribing omissions.• The prevalence of potentially inappropriate prescribing and prescribing omissions in the elderly population presenting to hospital with acute illness is high according to STOPP and START criteria. WHAT THIS STUDY ADDS • Potential errors of prescribing and of omission of medicines are prevalent among medically stable older people in primary care.• Screening tools should be incorporated into the everyday practice of primary care doctors and community pharmacists as a means of preventing potential errors of prescribing commission and prescribing omission in older people.AIMS Screening tools have been formulated to identify potentially inappropriate prescribing (IP) in older people. Beers' criteria are the most widely used but have disadvantages when used in Europe. New IP screening tools called Screening Tool of Older Person's Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) have been developed to identify potential IP and potential prescribing omissions (PPOs). The aim was to measure the prevalence rates of potential IP and PPOs in primary care using Beers' criteria, STOPP and START.METHODS Case records of 1329 patients ≥65 years old from three general practices in one region of southern Ireland were studied. The mean age ± SD of the patients was 74.9 ± 6.4 years, 60.9% were female. Patients' current diagnoses and prescription medicines were reviewed and the Beers' criteria, STOPP and START tools applied.RESULTS The total number of medicines prescribed was 6684; median number of medicines per patient was five (range 1–19). Overall, Beers' criteria identified 286 potentially inappropriate prescriptions in 18.3% (243) of patients, whilst the corresponding IP rate identified by STOPP was 21.4% (284), in respect of 346 potentially inappropriate prescriptions. A total of 333 PPOs were identified in 22.7% (302) of patients using the START tool.CONCLUSION Potentially inappropriate drug prescribing and errors of drug omission are highly prevalent among older people living in the community. Prevention strategies should involve primary care doctors and community pharmacists.

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“…[148] Furthermore, 25.3% of those older adults with anxiety disorders reported being prescribed benzodiazepines, whereas 3.8% reported being prescribed antidepressants. Indeed, benzodiazepines are the most common form of medication used to treat the elderly for anxiety disorders, despite the serious adverse effects they may cause, including increased risk of hip fracture [152] and impaired cognitive and psychomotor functioning. [153,154] Unfortunately, few randomized clinical trials (RCTs) have been conducted for both pharmacological and psychosocial treatments for anxiety disorders in the elderly population relative to the younger adult population.…”

Section: Treatment Efficacymentioning

confidence: 99%

Anxiety disorders in older adults: a comprehensive review

Wolitzky-Taylor¹,

Castriotta²,

Lenze³

et al. 2010

Depress. Anxiety

600

398

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This review aims to address issues unique to older adults with anxiety disorders in order to inform potential changes in the DSM-V. Prevalence and symptom expression of anxiety disorders in late life, as well as risk factors, comorbidity, cognitive decline, age of onset, and treatment efficacy for older adults are reviewed. Overall, the current literature suggests: (a) anxiety disorders are common among older age individuals, but less common than in younger adults; (b) overlap exists between anxiety symptoms of younger and older adults, although there are some differences as well as limitations to the assessment of symptoms among older adults; (c) anxiety disorders are highly comorbid with depression in older adults; (d) anxiety disorders are highly comorbid with a number of medical illnesses; (e) associations between cognitive decline and anxiety have been observed; (f) late age of onset is infrequent; and (g) both pharmacotherapy and CBT have demonstrated efficacy for older adults with anxiety. The implications of these findings are discussed and recommendations for the DSM-V are provided, including extending the text section on age-specific features of anxiety disorders in late life and providing information about the complexities of diagnosing anxiety disorders in older adults. Depression and Anxiety 27:190-211, 2010.

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Hazardous Benzodiazepine Regimens in the Elderly: Effects of Half-Life, Dosage, and Duration on Risk of Hip Fracture

Cited by 273 publications

References 40 publications

A prescrição de benzodiazepínicos no Brasil: uma análise da literatura

A prescrição de benzodiazepínicos no Brasil: uma análise da literatura

Potentially inappropriate prescribing in an Irish elderly population in primary care

Anxiety disorders in older adults: a comprehensive review

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