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...

The aim of this study was to assess the health conditions and use of health services among elderly users of benzodiazepines. The study was carried out in the city of Bambuí in Minas Gerais State, Brazil. Of 1,742 inhabitants aged over 60, 1,419 participated in the study. Information about benzodiazepine and the use of other medications was obtained by means of interviews and checking medication packaging. After adjustments for confounding variables, benzodiazepine remained significantly associated with poorer self reported health (prevalence ratio = 1.94 and 2.04 for reasonable and bad/very bad health, respectively), common mental disorders (1.33), myocardial infarction (1.42), number of doctor visits in the previous 12 months (1.90 and 2.24 for 2-3 and 4+ visits, respectively) and concomitant use of other medications (1.84 and 1.83 for 2-4 and 5+ medications). The results showed that the factors associated with the use of benzodiazepine were similar to those observed in the elderly in higher income countries. The concomitant use of benzodiazepines and two or more medications was highly prevalent (59.5%), characterizing a situation of risk, which deserves attention as a public health problem.

ResumoObjetivo: Compreender a percepção e os significados que os idosos atribuem a suas experiências relacionadas ao uso prolongado de benzodiazepínicos. Métodos: Trabalho de abordagem qualitativa, de cunho antropológico, realizado junto a idosos participantes do Projeto Bambuí, estudo de base populacional sobre as condições de saúde da população idosa, realizado na cidade de Bambuí-MG. Foram realizadas entrevistas semiestruturadas com 22 idosos, sem comprometimento cognitivo e residentes na cidade de Bambuí-MG, que relataram uso de medicação benzodiazepínica. Resultados: No grupo pesquisado, o uso de benzodiazepínicos foi compatível com a definição de "padrão de uso crônico", variando de seis meses a 40 anos, sendo o medicamento mais utilizado o Clonazepam. A coleta e análise dos dados foram guiadas pelo modelo de signos, significados e ações. Emergiram como categorias: a utilização de um remédio "muito bom"; o remédio bom que "parece que vicia"; a (des)obediência à prescrição médica; e o alívio. Conclusão: Os idosos entrevistados justificam o uso crônico de benzodiazepínicos como um paliativo para lidar com dificuldades existenciais decorrentes de situações culturais, sociais e familiares, as quais precisam ser abordadas nos serviços de saúde. AbstractObjective: To understand the perception and meanings that elderly give to their experiences as related to prolonged use of benzodiazepines. Methods: Using an anthropological qualitative methodology of qualitative approach, the study was conducted among elderly participants in the Bambuí Project, a population-based study on the health JaneiRo, 2015; 18(2):249-258 status of the elderly, in the city of Bambuí, Minas Geraisstate, Brazil. Semi-structured interviews were conducted with 22 elderly without cognitive impairment and residents in Bambuí-MG, who reported use of benzodiazepines. Results: In the study group, the use of benzodiazepines was compatible with the definition of "pattern of chronic use", ranging from 6 months to 40 years, and the most used drug was Clonazepam. The collection and analysis were guided by the model of signs, meanings and actions. These categories emerged: use of a "very good" drug; the good medicine that "seems addictive"; (dis)obedience to the prescription; and relief. Conclusion: The elderly respondents justify the chronic use of benzodiazepines as a palliative to deal with existential difficulties arising from cultural, social and family situations, which need to be addressed in the health services. Uma revisão sobre efetividade clínica, custobenefício e diretrizes sobre o uso de BZD em idosos concluiu que as evidências disponíveis sugerem maiores chances de eventos cognitivos e psicomotores adversos entre os usuários de BZD, 4 tais como quedas e fraturas. Nenhum trabalho avaliou com precisão a segurança, eficácia clínica e custo-efetividade do uso de BZD no tratamento de ansiedade ou problemas de comportamento em idosos. Apesar disso, a prevalência do seu consumo nesse segmento etário mantém-se muito elevada -cerca de 30% -, mui...

OBJECTIVETo analyze the perception of and motivation for the chronic use of benzodiazepine among older adults.METHODSA qualitative study was conducted on 22 older adults living in Bambuí, MG, Southeastern Brazil, who were taking benzodiazepines and had the clinical and cognitive ability to respond to interview questions. The collected data were analyzed on the basis of the “signs, meanings, and actions” model.RESULTSThe main reasons pointed out for the use of benzodiazepines were “nervousness”, “sleep problems”, and “worry” due to family and financial problems, everyday problems, and existential difficulties. None of the interviewees said that they used benzodiazepines in a dose higher than that recommended or had been warned by health professionals about any risks of their continuous use. Different strategies were used to obtain the prescription for the medication, and any physician would prescribe it, indicating that a bond was established with the drug and not with the health professional or healthcare service. Obtaining and consuming the medication turned into a crucial issue because benzodiazepine assumes the status of an essential food, which leads users to not think but sleep. It causes a feeling of relief from their problems such as awareness of human finitude and fragility, existential difficulties, and family problems.CONCLUSIONSBenzodiazepine assumes the characteristics of polyvalence among older adults, which extrapolate specific clinical indications, and of essentiality to deal with life’s problems in old age. Although it relieves the “nerves”, the chronic use of benzodiazepines buffers suffering and prevents older adults from going through the suffering. This shows important difficulties in the organization and planning of strategies that are necessary for minimizing the chronic use in this population.

Objective: This article aims to describe the adaptation and translation process of the Bush-Francis Catatonia Rating Scale (BFCRS) and its reduced version, the Bush-Francis Catatonia Screening Instrument (BFCSI) for Brazilian Portuguese, as well as its validation. Methods: Semantic equivalence processes included four steps: translation, back translation, evaluation of semantic equivalence and a pilot-study. Validation consisted of simultaneous applications of the instrument in Portuguese by two examiners in 30 catatonic and 30 non-catatonic patients. Results: Total scores averaged 20.07 for the complete scale and 7.80 for its reduced version among catatonic patients, compared with 0.47 and 0.20 among non-catatonic patients, respectively. Overall values of inter-rater reliability of the instruments were 0.97 for the BFCSI and 0.96 for the BFCRS. Conclusion: The scale's version in Portuguese proved to be valid and was able to distinguish between catatonic and non-catatonic patients. It was also reliable, with inter-evaluator reliability indexes as high as those of the original instrument.