Older primary care patients' willingness to consider discontinuation of chronic benzodiazepines

Cook, Joan M.; Biyanova, Tatyana; Thompson, Richard; Coyne, James C.

doi:10.1016/j.genhosppsych.2007.07.001

Cited by 28 publications

(18 citation statements)

References 38 publications

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“…Of note, additional screening measures in a group of Philadelphia primary care clinics observed that those patients with lower frequency of use and less anxiety were more likely to be willing to engage in tapering or discontinuing their benzodiazepine use. 41 …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A Systematic Review of Opioid and Benzodiazepine Misuse in Older Adults

Maree

Marcum

Saghafi

et al. 2016

The American Journal of Geriatric Psychiatry

106

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Objectives We aimed to assess the prevalence of opioid and benzodiazepine prescription drug misuse in older adults, the risk factors associated with misuse, and age-appropriate interventions. Methods Following PRISMA guidelines, we conducted a literature search for reports on misuse of prescription benzodiazepines and opioids in older adults. We searched PubMed, PsycINFO, and EMBASE for peer reviewed journal articles in English through April 2014 with updates through November 2015. We reviewed relevant publications that included participants ≥ 65 years of age. We also manually searched reference lists of key identified articles and geriatric journals through April 2016. Information on the study design, sample, intervention, comparators, outcome, time frame, and risk of bias were abstracted for each article. Results Of 4932 reviewed reports, 15 were included in this systematic review. Thirteen studies assessed the prevalence of prescription drug misuse and included studies related to opioid shopping behavior, assessment of morbidity and mortality associated with opioid and/or benzodiazepine use, frequency and characteristics of opioid prescribing, frequency of substance use disorders and non-prescription use of pain relievers, and the health conditions and experiences of long-term benzodiazepine users. One study identified risk factors for misuse and one study described the effects of provider education and an electronic support tool as an intervention. Discussion There is a dearth of high quality research on prescription drug misuse in older adults. Existing studies are heterogeneous, making it difficult to draw broad conclusions. We discuss the need for further research specific to prescription drug misuse among older adults.

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Section: Discussionmentioning

confidence: 99%

“…While these studies did not meet criteria for this review, they may provide ideas for formulating research and interventions related to older adults and prescription medication misuse. 7,13,15,38,41–47,50,57–65 …”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of Opioid and Benzodiazepine Misuse in Older Adults

Maree

Marcum

Saghafi

et al. 2016

The American Journal of Geriatric Psychiatry

106

View full text Add to dashboard Cite

show abstract

“…An assessment procedure based on self-rated addiction also might help nurses uncover potential substance dependence. Developing this knowledge is essential for nurses because clinicians tend to overlook BZD dependence among the elderly (Voyer, Cappeliez, Pérodeau, & Préville, 2005;Voyer, Cohen, Lauzon, & Collin, 2004b;Voyer & Schindel-Martin, 2003), downplay its clinical significance (Anthierens et al, 2007;Cook, Marshall, Masci, & Coyne, 2007;Damestoy, Collin, & Lalande, 1999), fail to identify its presence or do not discuss the issue with their patients despite their being aware of the risk of dependence (Anthierens et al, 2007;Cook, Biyanova, Masci et al, 2007;Cook, Biyanova, Thompson, & Coyne, 2007;Pimlott et al, 2003). Asking a single, simple and direct question of older adults such as: "Do you think you are dependent on your BZD" is easy to administer, and recent studies and various scales have supported the clinical relevance of doing so.…”

Section: The Study Of Feeling Addictedmentioning

confidence: 99%

Factors Associated with Self-Rated Benzodiazepine Addiction among Community-Dwelling Seniors

Voyer

Préville

Martin

et al. 2011

Journal of Addictions Nursing

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Long-term use of benzodiazepines carries considerable personal consequences such as memory loss and functional impairment. In addition, use over time may bring about dependence and habituation thus leading older persons to believe they cannot discontinue the drug and to experience withdrawal symptoms should its use suddenly cease. The frequency of such negative consequences remains unclear. The purpose of this study is to determine the prevalence of self-rated addiction among older persons and its associated factors. Face-to-face computer-assisted interviews were conducted in the homes of 2,785 persons aged 65 years and over, randomly selected from across the Province of Quebec, Canada. Of the 707 users of benzodiazepines, 43% considered themselves addicted. They were more likely to be 75 years or over, to suffer from panic disorder, to believe that health professionals are ready and available to discuss emotional problems with them, and to be less than satisfied with their social relationships. This study showed that a large proportion of benzodiazepine users rated themselves as addicted. These findings indicate that it is important for nurses to screen older adults living in the community to identify those who continue to use benzodiazepine beyond the recommended therapeutic time frame, perceive themselves to be dependent, and could potentially benefit from participation in a withdrawal program.

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“…As pointed out by a qualitative study in 50 users aged 61-95 years [18,19], many depend on BZDs for their unique soothing effects, and denied and minimized side effects. They showed reluctance to discontinue or taper the medication down, fearing suffering without it, and perceived such a measure an arduous, low priority and time-intensive task.…”

Section: Do Older Patients Have Higher Risks?mentioning

confidence: 99%

Current use of benzodiazepines in anxiety disorders

Cloos¹,

Ferreira²

2009

Current Opinion in Psychiatry

114

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Despite current guidelines, benzodiazepines are still considered by many clinicians to remain good treatment options, in both the acute and the chronic phase of the treatment of anxiety disorders, partially because of their rapid onset of action and their efficacy with a favourable side effect profile, and also because of the sometimes only incomplete therapeutic response and the emergence of side effects of alternative medications. Having experienced good initial symptom relief with benzodiazepine treatment, patients may also be reluctant to taper it down. Clinicians should, however, bear in mind the frequent physiological dependence associated with these substances, and suggest both pharmacological and psychological treatment alternatives before opting for a long-term benzodiazepine treatment, which may remain necessary in certain clinical conditions.

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Older primary care patients' willingness to consider discontinuation of chronic benzodiazepines

Cited by 28 publications

References 38 publications

A Systematic Review of Opioid and Benzodiazepine Misuse in Older Adults

A Systematic Review of Opioid and Benzodiazepine Misuse in Older Adults

Factors Associated with Self-Rated Benzodiazepine Addiction among Community-Dwelling Seniors

Current use of benzodiazepines in anxiety disorders

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