Benzodiazepine Use in Older Adults: Dangers, Management, and Alternative Therapies

Markota, Matej; Rummans, Teresa A.; Bostwick, John; Lapid, Maria I.

doi:10.1016/j.mayocp.2016.07.024

Cited by 171 publications

(121 citation statements)

References 23 publications

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“…31 Thus, use of anticholinergic drugs should generally be avoided among people with dementia. 32 A systematic review looking at the use of benzodiazepines in people with AD found a high prevalence of benzodiazepine use, ranging from 8.5% to 20%, 33 which is in line with our findings. 31 In our study, the prescribing of benzodiazepines for periods of 4 weeks or longer was the second most common STOPP criteria, occurring in more than 27% of people dispensed medicines for dementia.…”

Section: Prevalence Of Individual Stopp Criteriasupporting

confidence: 89%

Potentially inappropriate prescribing in people with dementia: An Australian population‐based study

Eshetie

Nguyen

Gillam

et al. 2019

Int J Geriat Psychiatry

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Objective To investigate the prevalence of potentially inappropriate prescribing (PIP) using the Screening Tool of Older Person's Prescriptions (STOPP) criteria in people with dementia compared with people without dementia. Methods A retrospective cohort study was conducted using the Pharmaceutical Benefits Scheme 10% sample of pharmacy claims. People with dementia were defined as those dispensed a medicine for dementia (cholinesterase inhibitors, memantine, or risperidone for behavioural and psychological symptoms of dementia) between 1 January 2005 and 31 December 2015, aged 65 years or older at 1 January 2016 and alive at the end of 2016. An age‐ and gender‐matched comparison cohort of people not dispensed medicines for dementia was identified. PIP prevalence was determined between 1 January 2016 and 31 December 2016. Results In total, 8280 people dispensed medicines for dementia and 41 400 comparisons not dispensed medicines for dementia were included: 63% were female and the median age was 82 years. PIP prevalence was 79% among people with dementia compared with 70% among the comparison group (P < .0001). Use of anticholinergics, long‐term use of high‐dose proton pump inhibitors, and use of benzodiazepines were the most common instances of PIP in people with dementia. After adjustments for age, gender, comorbidity, and number of prescribers, people with dementia were more likely to be exposed to PIP than comparisons (adjusted OR 1.44, 95% CI, 1.35‐1.53, P < .0001). Conclusions PIP was more common in people dispensed medicines for dementia than comparisons. These results highlight the need for effective interventions to optimize prescribing in people with dementia.

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Section: Prevalence Of Individual Stopp Criteriasupporting

confidence: 89%

Potentially inappropriate prescribing in people with dementia: An Australian population‐based study

Eshetie

Nguyen

Gillam

et al. 2019

Int J Geriat Psychiatry

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“…Many were receiving anticholinergic medications or benzodiazepines, recommended to be avoided in patients with delirium and DEM 27,28. This finding is consistent with research in other care settings where delirium symptoms overshadow DEM symptoms when comorbid.…”

supporting

confidence: 77%

Distinguishing characteristics of delirium in a skilled nursing facility in Spain: Influence of baseline cognitive status

Vásquez

Trzepacz

Gaviria

et al. 2019

Int J Geriat Psychiatry

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Objective Mild cognitive impairment (MCI) and dementia (DEM) are prevalent in skilled nursing facilities (SNFs), confounding delirium detection. We report characteristics of delirium in an SNF to ascertain distinguishing features for delirium diagnosis, despite challenges of comorbidity with MCI and DEM. Methods Cross‐sectional study of 200 consecutive patients from an SNF in Catalunya, Spain, assessed within the first 24 to 48 admission hours by independent experts with Spanish‐Informant Questionnaire on Cognitive Decline in the Elderly (for MCI‐DEM), Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5) delirium criteria, and Delirium Rating Scale Revised‐98 (DRS‐R98) for delirium phenomenology. Delirium characteristics were modeled in successive steps, according to the presence of delirium and MCI‐DEM, with analysis of variance (ANOVA), receiver operator characteristic analyses, and conditional logistic regression. Results The final model produced symptoms that represented each of the three delirium core domains (ie, cognitive, higher order thinking, and circadian). The DRS‐R98 items rated these symptoms as moderate‐severe attention/vigilance, mild‐severe language, and moderate‐severe sleep‐wake cycle alterations. The delirium discriminant accuracy of the three symptoms together was high: 84.6% in the MCI‐DEM group to 92.8% in the No MCI‐DEM group. Conclusions Impairments of attention, language, and sleep‐wake cycle indicate delirium in SNF patients regardless of the underlying MCI‐DEM status. Because delirium is underdetected in SNFs, where nursing staff/patient ratios are low, brief simple tools that measure these symptoms could potentially enhance delirium detection.

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“…Therefore, professionals who prescribe this type of medication need to pay attention and carefully evaluate the real need for this therapy, prioritizing pharmacological and non-pharmacological measures that are alternative to their use (41) .…”

Section: Discussionmentioning

confidence: 99%

Knowledge produced on the health of low-income older women: an integrative review

et al. 2017

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Objective: to identify the knowledge produced on the health of low-income older women. Method: an integrative review was conducted in February 2016 on the SCOPUS, CINAHL, MEDLINE, LILACS, EMBASE, WEB OF SCIENCE databases, and in the SciELO journals directory. After the application of inclusion and exclusion criteria, 24 articles were selected. Results: the knowledge produced comprises two main themes: "health in face of economic adversities" and "reciprocity in social support between low-income older women and their social network". Final considerations: health professionals, especially nurses, should be attentive to aspects related to social determinants and the health of low-income older women, highlighting the fact that they are not always the recipients of care. Descriptors: Poverty; Elderly; Social Support; Women's Health; Public Health Nursing. RESUMO Objetivo: identifi car o conhecimento produzido sobre a saúde das mulheres idosas de baixa renda. Método: revisão integrativa realizada em fevereiro de 2016, nas bases de dados SCOPUS, CINAHL, MEDLINE, LILACS, EMBASE, WEB OF SCIENCE e no diretório de revistas SciELO. Após aplicação dos critérios de inclusão e exclusão, foram selecionados 24 artigos. Resultados: o conhecimento produzido congrega dois temas principais: "a saúde diante das adversidades econômicas" e "reciprocidade no apoio social entre as mulheres idosas de baixa renda e sua rede social". Considerações fi nais: os profi ssionais de saúde, em especial o enfermeiro, devem atentar para aspectos relacionados aos determinantes sociais e de saúde de mulheres idosas de baixa renda, destacando-se que elas, nem sempre, são apenas receptoras de cuidado. Descritores: Pobreza; Idoso; Apoio Social; Saúde da Mulher; Enfermagem em Saúde Pública. RESUMENObjetivo: identifi car el conocimiento producido sobre la salud de las mujeres ancianas de bajos ingresos. Método: revisión integrativa realizada en febrero de 2016, en las bases de datos SCOPUS, CINAHL, MEDLINE, LILACS, EMBASE, WEB OF SCIENCE y en el directorio de revistas SciELO. Una vez aplicados los criterios de inclusión y exclusión, fueron seleccionados 24 artículos. Resultados: el conocimiento producido incluye dos temáticas principales: "la salud frente a las adversidades económicas" y "reciprocidad en el apoyo social entre las mujeres ancianas de bajos ingresos y su red social". Consideraciones fi nales: los profesionales de salud, en particular el enfermero, deben brindar atención a aspectos relacionados a los determinantes sociales y de salud de mujeres ancianas de bajos ingresos, destacándose que las mismas no son siempre receptoras de cuidado.

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Benzodiazepine Use in Older Adults: Dangers, Management, and Alternative Therapies

Cited by 171 publications

References 23 publications

Potentially inappropriate prescribing in people with dementia: An Australian population‐based study

Potentially inappropriate prescribing in people with dementia: An Australian population‐based study

Distinguishing characteristics of delirium in a skilled nursing facility in Spain: Influence of baseline cognitive status

Knowledge produced on the health of low-income older women: an integrative review

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