Cet article passe en revue la littérature concernant la dépendance aux benzodiazépines (BZD) chez la population des personnes âgées de 65 ans et plus. Alors que les conséquences négatives reliées à l’utilisation prolongée des BZD sont bien connues, le phénomène de la dépendance à ces substances chez cette population l’est beaucoup moins. Il n’existe toujours pas de consensus autour de la définition du problème. L’usage continu des BZD peut être davantage problématique chez les personnes âgées pour qui la tolérance aux agents chimiques diminue avec l’âge. Les facteurs de risque impliqués dans l’usage chronique sont une combinaison interactive entre les caractéristiques des aînés et celles des médecins prescripteurs. Des pistes de recherche étayées sur un changement paradigmatique sont lancées afin de bonifier la recherche dans ce domaine.This article reviews the literature concerning addiction to benzodiazepine (BZD) in the elderly population of 65 and over. While the negative consequences related to a prolonged use of BZD are well known, much less is known on the phenomenon of dependency to these substances in this population. There is still no consensus on the definition of the problem. The continuous use of BZD may be more problematic in the elderly for whom tolerance to chemical agents diminishes with age. The risk factors involved in the chronic use are an interactive combination between the charateristics of the elderly as well as the physicians who prescribe such medication. Paths of research to support a paradigmatic change are presented in order to improve the research in this field.Este artículo examina sucesivamente la literatura concerniente a la dependencia de benzodiacepinas (BDZ) en la población de 65 años y más. Mientras que las consecuencias negativas relacionadas con el uso prolongado de las BZD son muy conociadas, el fenómeno de dependencia de estas substancias en esta población es mucho menor. No existe aún un concenso sobre la definición del problema. El uso continuo de BZD puede ser más problemático en las personas de edad avanzada, cuya tolerancia a los agentes químicos disminuye con la edad. Los factores de riesgo implicados en el uso crónico son una combinación interactiva entre las características de los ancianos y las de los médicos que las prescriben. Se lanzan pistas de investigación apoyadas en un cambio paradigmático a fin de mejorar la investigación en este campo.Este artigo passa em revista a literatura sobre a dependência das benzodiazepinas (BZD) na população das pessoas com 65 anos ou mais. Ao passo que as conseqüências negativas relacionadas com a utilização prolongada das BZD são bem conhecidas, o fenômeno da dependência a estas substâncias na população idosa é muito menos conhecida. Ainda não existe consenso a respeito da definição do problema. O uso contínuo das BZD pode ser muito mais problemático em pessoas idosas, onde a tolerância a agentes químicos diminui com a idade. Os fatores de risco implicados no uso crônico são uma mistura interativa entre as características dos ...
Background Patients with limited ability to communicate cannot have a proper evaluation of pain using self-evaluation tools. Therefore they might not receive the appropriate analgesic treatment. Our audience was the medical and paramedical staff of our hospital. These people are involved in care management of patients with limited ability to communicate. Purpose The objectives of the study were to assess their knowledge and to evaluate their motivation to use appropriate tools: the behavioural tools. Materials and methods A questionnaire was sent out to all medical and nursing staff in osteoarticular wards (rheumatology and orthopaedics) and had to be completed the same day. The people queried work in outpatient and conventional wards. The main outcome measured the existence of tools to evaluate acute pain, the sensitivity of staff to patients with limited ability to communicate, and the staff’s awareness and knowledge of existing behavioural tools. Results A total of 53 questionnaires was returned. The function of the participants was divided as follows: nurses (65%), nursing auxiliaries (30%), residents and physiotherapist (about 5%). A large majority (94%) reported that they evaluated patient pain using a self-report tool. The rest of the participants admitted that they were not using any instruments. To the question ‘Have you identified in your ward the presence of patients with limited ability to communicate?’, we obtain a 100% of positive answers by the orthopaedics ward staff, against 58% only in the rheumatology ward. Despite the fact that behavioural tools are not used in these 2 wards 20% of the staff acknowledged their existence and a few of them were able to name a specific tool. The overall majority (87%) of staff members were keen to use a behavioural tool in their daily practice. The others (13%) didn’t know about them but were not opposed to learning. However, they requested a decision-making template to choose the right tool. Conclusions Within the two wards, we observed a real difference in identifying the presence of patients with limited ability to communicate. This observation was not expected. It may highlight the fact that the medical and nursing staff are not sufficiently trained to identify such patients’impairment in some wards. There is a need to ensure appropriate identification of this sub-group of patients and to be able to offer them an appropriate tool with which to rate and communicate the severity of their pain. The staff motivation was very encouraging for setting up behavioural assessment tools. This should lead to the correct use of analgesic drugs which are delivered by hospital pharmacists. No conflict of interest.
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