Is There a Rationale for Prescription of Benzodiazepines in the Elderly? Review of the Literature

Petrovic, Mirko; Mariman, An; Warie, H; Afschrift, Marcel; Pevernagie, Dirk

doi:10.1179/acb.2003.58.1.004

Cited by 70 publications

(38 citation statements)

References 71 publications

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“…12,28 Thus, the effect of the medication, which is already of slow elimination, is exacerbated, causing possible daytime sleepiness, falls and cognitive deficit. 29 The use of benzodiazepines observed in this study presented a pattern which is compatible with chronic use (approximately two-thirds of the older adults have been using the medication for at least 12 months). Even though the present study has not considered the number of daily doses and the dosage of benzodiazepines, this result is worrisome.…”

Section: -9supporting

confidence: 67%

Prevalence and sociodemographic characteristics associated with benzodiazepines use among community dwelling older adults: the Bambuí Health and Aging Study (BHAS)

Alvarenga

Filho

Firmo

et al. 2007

Rev. Bras. Psiquiatr.

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Introduction Fear or anxious apprehension are emotional responses to danger or threat. For thousands of years humans have used diverse substances to alleviate this negative emotional state. One of the first tranquilizers used, and which continues to be consumed until today, is alcohol; others followed, such as barbiturates, bromides and meprobamates. 1 Since they were released in the market in 1960, the benzodiazepines became the most prescribed drugs and the most used to combat anxiety and insomnia in the whole world.2 This use stemmed from their efficiency, security, and lower potential to cause dependence, their tolerance as well as wide therapeutic applicability. 3 Nonetheless, the use of benzodiazepines has been associated with several adverse effects, such as motor disturbances, falls, daytime sleepiness and cognitive decline. The modifications in metabolism which accompany the ageing process make the elderly an especially vulnerable age group to these undesirable medication effects, 3 which are even worse when long half-life benzodiazepines are used for prolonged periods, especially when not accompanied by an adequate clinical monitoring. 4 The use of benzodiazepines is frequent among the elderly. Although a decrease in prescribing benzodiazepines for the elderly has been observed in some studies, 5,6 population-based studies continue to demonstrate high prevalences in the consumption of these medications in developed countries, and levels ranged from 20.0% in Canada 7 to 31.9% in France.8 With respect to the type of benzodiazepines most used, there is a diversity of results in different countries.8-10 It has been described that female gender is the sociodemographic characteristic most consistently found to be associated with the use of benzodiazepines among the elderly. 5,6,8,9,11 Brazilian epidemiological studies on the use of benzodiazepines among the elderly dealt with selected populations and/or investigated specific associations, such as the occurrence of falls.12-15 Populationbased studies on the consumption of these medications have been accomplished on younger individuals, 16,17 and the benzodiazepine consumption was investigated in a much wider context, which was the use of psychopharmacs. [18][19][20] The population-based studies showed benzodiazepines as the most commonly used psychopharmacs in the adult population, [17][18][19][20] and among these, Diazepam was the most used chemical substance. 16,18,19 In these studies, the consumption of benzodiazepines was higher among women, 16,17 among older subjects and among the wealthy. 17To our knowledge, there are no Brazilian studies on the profile of use of benzodiazepines among community-dwelling older adults. As the use of these medications among the elderly is more frequent and involves greater risks and taking into consideration the rapid aging of the Brazilian population, 21 it is important to investigate this question in greater detail in this country.The present study has the following objectives: 1) to determine the prevalence of be...

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Section: -9supporting

confidence: 67%

Prevalence and sociodemographic characteristics associated with benzodiazepines use among community dwelling older adults: the Bambuí Health and Aging Study (BHAS)

Alvarenga

Filho

Firmo

et al. 2007

Rev. Bras. Psiquiatr.

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“…High benzodiazepine utilisation in older adults is especially worrying, since age-related pharmacokinetic-and dynamic alterations may lead to an increased risk of amnesia, confusion, sedation [16,17], hangover effects [18,19] and consecutive risk of falling [20].…”

Section: Introductionmentioning

confidence: 99%

Benzodiazepine use in Belgian nursing homes: a closer look into indications and dosages

Bourgeois

Elseviers

Azermai

et al. 2011

Eur J Clin Pharmacol

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AIM:(i)To describe the prevalence of benzodiazepine use in Belgian nursing homes, with specific attention to indications and dosages.(ii)To compare actual and recommended dosages of benzodiazepines for anxiety and insomnia.(iii)To explore the risk profile for chronic benzodiazepine use in institutionalised older adults. METHODS:Medication charts of 1730 residents from 76 nursing homes in Belgium were collected and analysed, using the ATC classification. Drug name, indication and daily dosage were recorded. From authoritative international sources, we extracted for each drug and each indication a daily dosage recommended not to exceed in older adults, for comparison with observed actual dosages. RESULTS:Among the chronic BZD/Z users (50% of the residents), the leading indication was 'insomnia' (59% of the users) followed by 'anxiety' (17%) and 'unrest' (10%). In the chronic prescriptions of BZD/Zs indicated for insomnia, the actual daily dose exceeded the geriatric upper limit: with lormetazepam in 95% ,zolpidem in 82%, zopiclone in 78% and lorazepam in 35% of the prescriptions. In anxiety, daily doses also exceeded the limit but not to the same extend.Multivariate analysis showed BZD/Z use was positively associated with pain (OR 1.58 CI95% 1.27-1.97), constipation ) and depression (OR 1.68 CI95% 1.35-2.08). Residents with dementia were less likely of receiving a BZD/Z (OR 0.60 CI95% 0.48-0.74). CONCLUSION:Efforts to reduce the use of BZD/Zs in nursing homes should concentrate on insomnia, with interventions aimed to reduce too high prevalence of chronic use and too high daily dosages in this indication.3

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“…Older patients are especially at risk for impaired cognitive and movement function, with an increased risk of inappropriate sedation, falls and fractures [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

The use of hypnosedative drugs in a university hospital: has anything changed in 10 years?

Somers

Robays

Audenaert

et al. 2011

Eur J Clin Pharmacol

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Is There a Rationale for Prescription of Benzodiazepines in the Elderly? Review of the Literature

Cited by 70 publications

References 71 publications

Prevalence and sociodemographic characteristics associated with benzodiazepines use among community dwelling older adults: the Bambuí Health and Aging Study (BHAS)

Prevalence and sociodemographic characteristics associated with benzodiazepines use among community dwelling older adults: the Bambuí Health and Aging Study (BHAS)

Benzodiazepine use in Belgian nursing homes: a closer look into indications and dosages

The use of hypnosedative drugs in a university hospital: has anything changed in 10 years?

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