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Elderly overprescribed sedatives and anti-anxiety drugs
December 31, 2014 / 5:02 PM / 3 years ago

Elderly overprescribed sedatives and anti-anxiety drugs

(Reuters Health) - Doctors often prescribe potentially disabling tranquilizers to older Americans, particularly women, a new study shows.

Nearly 12 percent of 80-year-old women in 2008 used benzodiazepines, a class of sedatives and anti-anxiety drugs that the American Geriatrics Society says should generally be avoided in the elderly, U.S. pharmacy data revealed.

Benzodiazepines include alprazolam (brand name Xanax), lorazepam (Ativan) and diazepam (Valium) – “a little yellow pill” that the Rolling Stones dubbed “mother’s little helper” in the band’s 1966 rock classic.

“The study should be a call to action for us to think about why these medications are being prescribed so greatly in a very vulnerable group,” geriatric nurse Donna Fick told Reuters Health.

“These drugs have very dangerous side effects – falls, delirium, and they have been linked to dementia,” said Fick, a Pennsylvania State University professor, who was not involved in the current study.

Data from 60 percent of U.S. retail pharmacies showed that more than six percent of men and almost 11 percent of women between the ages of 65 and 80 used benzodiazepines in 2008, Dr. Mark Olfson and colleagues report in JAMA Psychiatry.

Almost one-third of older adults used the tranquilizers on a long-term basis, for four months or more, the data showed.

“These are worrisome patterns, especially for older adults and particularly for women,” Olfson told Reuters Health.

“Benzodiazepines should only be used for short periods of time, yet if we look at the prescribing practices of doctors in the U.S., we see a very different picture,” said Olfson, a psychiatry professor at Columbia University Medical Center in New York.

Benzodiazepines are effective for short-term treatment of anxiety and sleep problems but risky and of questionable value for long-term use, particularly in the elderly, he and his colleagues noted.

In older people, research has shown that benzodiazepines increase the risks of falls and can impair cognition, mobility and driving skills.

Furthermore, long-term use can make it harder for people to stop taking the drugs. They may suffer dependence and withdrawal symptoms when the drugs are discontinued, the authors say.

An editorial published with the report suggests that benzodiazepines should perhaps be classed with dangerous addictive substances, limiting prescription duration and prohibiting refills.

“Benzodiazepines are far from safe,” said Dr. Nicholas Moore and colleagues from the University of Bordeaux in France, in the editorial.

Moore and his coauthors suggest that one way to reign in overprescribing would be to allow only psychiatrists to write benzodiazepine prescriptions. Olfson’s study found that primary-care physicians wrote most of the prescriptions for older men and women; psychiatrists wrote fewer than six percent of them.

Olfson would prefer to try to curb benzodiazepine use with lifestyle changes to ease anxiety and improve sleep.

“You can reduce the use of these medications through legislation, but I don’t know that you’ll improve the quality of care very much,” he said. “A smarter way forward would be to increase non-pharmacological treatments for sleep and anxiety.”

Benzodiazepines are prescribed to older people primarily for insomnia, but behavioral interventions work better in the long run, the authors write.

Olfson advises patients with sleep problems to increase their exercise and exposure to light and learn techniques for winding down at the end of the day.

Fick also advises people with sleep difficulties to try a series of behavioral modifications. They include not drinking caffeine after 11 a.m., drinking warm milk or herbal tea at bedtime, increasing exposure to light and exercise and avoiding naps.

A 1998 study showed that a back rub, a warm drink and listening to a relaxation tape provided a feasible alternative to sedatives for elderly, hospitalized patients, Fick noted (1.usa.gov/1wyxthv).

“You can’t just tell patients not to take these drugs,” she said. “You have to give patients alternatives.”

“It might be easier to say, ‘Let me give you a milligram of Ativan two or three times a day,’ instead of saying, ‘Let’s get you in a walking group or restorative yoga,’ ” she said. “You need to have time to do that.”

SOURCES: bit.ly/1v4Tsgy and bit.ly/1AwKhJz JAMA Psychiatry, online December 17, 2014.

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