Efficacy and Tolerability of Benzodiazepines for the Treatment of Behavioral and Psychological Symptoms of Dementia

Tampi, Rajesh R.; Tampi, Deena J.

doi:10.1177/1533317514524813

Cited by 68 publications

(36 citation statements)

References 55 publications

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“…Benzodiazepines (in our sample: diazepam, medazepam, clobazam, chlordiazepoxide, nitrazepam) and benzodiazepine-related drugs (in our sample: zolpidem, zopiclone) are often used in older adults for the treatment of insomnia, depression, or anxiety. In addition, they are used often to treat behavioral symptoms of dementia, despite the lack of evidence for their effectiveness [48]. …”

Section: Discussionmentioning

confidence: 99%

Potentially Inappropriate Medication in Community-Dwelling Primary Care Patients who were Screened Positive for Dementia

Wucherer

Eichler

Hertel

et al. 2016

JAD

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Background: Potentially inappropriate medication (PIM) in older people is a risk factor for adverse drug effects. This risk is even higher in older people with dementia (PWD).Objective: Our study aimed to determine (1) the prevalence of PIM among primary care patients who were screened positive for dementia and (2) the sociodemographic and clinical variables associated with the use of PIM.Methods: DelpHi-MV (Dementia: life- and person-centered help in Mecklenburg–Western Pomerania) is a general practitioner-based, cluster-randomized, controlled intervention study to implement and evaluate an innovative concept of collaborative dementia care management in Germany. The comprehensive baseline assessment includes a home medication review. The present analyses are based on the data from 448 study participants (age 70+, DemTect <9). PIMs were identified using the list of Potentially Inappropriate Medications in the Elderly (Priscus).Results: (1) A total of 99 study participants (22%) received at least one PIM. The highest prevalence was found for antidepressants, benzodiazepines, and analgetics. The most frequently prescribed PIMs were amitriptyline, etoricoxib, and doxazosin. (2) Use of a PIM was significantly associated with a diagnosis of a mental or behavioral disorder.Conclusions: The prescription rate of PIMs for community-dwelling PWD was comparable with the rates found for the general population of older people in Germany (20–29%). Antidepressants with anticholinergic properties and long-acting benzodiazepines were the most prescribed PIMs, despite having an unfavorable benefit-risk ratio. This high prevalence of PIM prescriptions in a vulnerable population of PWD indicates that standard care for dementia should include careful medication review and management.

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Section: Discussionmentioning

confidence: 99%

Potentially Inappropriate Medication in Community-Dwelling Primary Care Patients who were Screened Positive for Dementia

Wucherer

Eichler

Hertel

et al. 2016

JAD

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“…Midazolam was commonly used, which is of concern given the lack of evidence for benzodiazepines in managing acute agitation in the elderly, their potential to worsen delirium,10 and the limited circumstances in which they are appropriate in the management of BPSD 30. Doses of haloperidol up to maximum 5 mg are of significant concern given its propensity for extrapyramidal side effects, dose-related mortality, and significant risk in dementia with Lewy bodies.…”

Section: Discussionmentioning

confidence: 99%

Behavioral emergency in the elderly: a descriptive study of patients referred to an Aggression Response Team in an acute hospital

Simpkins¹,

Peisah²,

Boyatzis³

2016

CIA

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AimThe management of severely agitated elderly patients is not easy, and limited guidelines are available to assist practitioners. At a Sydney hospital, an Aggression Response Team (ART) comprising clinical and security staff can be alerted when a staff member has safety concerns. Our aims were to describe the patient population referred for ART calls, reasons for and interventions during ART calls, and complications following them.MethodsPatients 65 years and older referred for ART calls in the emergency department or wards during 2014 were identified using the Incident Information Management System database and medical records were reviewed. Demographic and clinical data were collected.ResultsOf 43 elderly patients with ART calls, 30 had repeat ART calls. Thirty-one patients (72%) had underlying dementia, and 22 (51%) were agitated at the time of admission. The main reasons for ART calls were wandering and physical aggression. Pharmacological sedation was used in 88% of the ART calls, with a range of psychotropics, doses, and routes of administration, including intravenous (19%) and, most commonly, midazolam (53%). Complications were documented in 14% of cases where sedation was used.ConclusionWe observed a high frequency of pharmacological sedation among the severely agitated elderly, with significant variance in the choice and dose of sedation and a high rate of complications arising from sedation, which may be an underestimate given the lack of post-sedation monitoring. We recommend the development of guidelines on the management of behavioral emergency in the elderly patients, including de-escalation strategies and standardized psychotropic guidelines.

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“…Older people have increased sensitivity to adverse events, despite growing tolerance to the sedative effects [12]. Adverse events include daytime drowsiness, lethargy, fatigue, agitation, memory loss, impaired coordination and falls [14]. Benzodiazepines may also contribute to cognitive decline in people with dementia [15].…”

Section: Introductionmentioning

confidence: 99%

The association between benzodiazepine use and sleep quality in residential aged care facilities: a cross-sectional study

et al. 2016

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BackgroundBenzodiazepines are commonly prescribed in residential aged care facilities (RACFs) for their sedative and anxiolytic effects. The objective of this study was to investigate the association between benzodiazepine use and sleep quality in residents of RACFs.MethodsA cross-sectional study involving 383 participants was conducted in six Australian RACFs. Night-time sleep quality, day-time drowsiness and day-time napping behavior were assessed using a validated questionnaire. Logistic regression was used to compute adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for the association between benzodiazepine use and sleep quality. Covariates included pain, dementia severity, depression, insomnia and other sedative use.ResultsOf the 383 residents (mean age 87.5 years, 77.5% female), 96(25.1%) used a benzodiazepine on a regular basis. Residents who used long-acting benzodiazepines on a regular basis had higher night-time sleep quality than non-users (AOR = 4.00, 95%CI 1.06 – 15.15). Residents who used short-acting benzodiazepines on a PRN only basis had longer daytime napping times than non-users (AOR = 1.77, 95%CI 1.01 – 3.08). No benzodiazepine category was associated with day-time drowsiness.ConclusionsThe association between benzodiazepine use and sleep quality is dependent on the half-life and prescribing pattern of the benzodiazepine. Short-acting PRN benzodiazepines were associated with lower night time sleep quality and longer day-time napping compared to long-acting regular benzodiazepines. Longitudinal studies are needed to determine whether these findings reflect channeling of short-acting agents to residents at higher risk of sleep disorders.

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Efficacy and Tolerability of Benzodiazepines for the Treatment of Behavioral and Psychological Symptoms of Dementia

Cited by 68 publications

References 55 publications

Potentially Inappropriate Medication in Community-Dwelling Primary Care Patients who were Screened Positive for Dementia

Potentially Inappropriate Medication in Community-Dwelling Primary Care Patients who were Screened Positive for Dementia

Behavioral emergency in the elderly: a descriptive study of patients referred to an Aggression Response Team in an acute hospital

The association between benzodiazepine use and sleep quality in residential aged care facilities: a cross-sectional study

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