Benzodiazepine Misuse in the Elderly: Risk Factors, Consequences, and Management

被引:135
作者
Airagnes, Guillaume [1 ,2 ,3 ]
Pelissolo, Antoine [4 ]
Lavallee, Melanie [5 ,6 ,7 ]
Flament, Martine [8 ]
Limosin, Frederic [1 ,2 ,9 ]
机构
[1] Hop Univ Paris Ouest, AP HP, Pole Psychiat Addict, Paris, France
[2] Univ Paris 05, Fac Med, Sorbonne Paris Cite, Paris, France
[3] Hop Europeen Georges Pompidou, Ctr Ambulatoire Addictol, 20 Rue Leblanc, F-75908 Paris 15, France
[4] Univ Paris Est Creteil, Hop Henri Mondor, AP HP, IMRB,Fdn FondaMental,Serv Psychiat,INSERM,U955, Creteil, France
[5] Univ Laval, Dept Psychiat & Neurosci, Quebec City, PQ, Canada
[6] Ctr Integre Univ Sante & Serv Sociaux Capitale Na, Quebec City, PQ, Canada
[7] Inst Univ Cardiol & Pneumol Quebec, Quebec City, PQ, Canada
[8] Univ Ottawa, Mental Hlth Res Inst, Royal Ottawa Mental Hlth Ctr, Ottawa, ON, Canada
[9] INSERM, U894, Ctr Psychiat & Neurosci, Paris, France
关键词
Benzodiazepine; Hypnotic; Misuse; Overuse; Inappropriate use; Elderly; INAPPROPRIATE MEDICATION USE; OLDER-ADULTS; ALZHEIMERS-DISEASE; COGNITIVE FUNCTION; DRUG-USE; PRESCRIPTIONS; DEMENTIA; PREVALENCE; HYPNOTICS; PEOPLE;
D O I
10.1007/s11920-016-0727-9
中图分类号
R749 [精神病学];
学科分类号
100204 [神经病学];
摘要
Benzodiazepine (BZD) inappropriate use (i.e., misuse and overuse) is a worldwide public health problem. Despite current knowledge about increased sensitivity to side effects in the elderly, that should lead to more caution, only a third of BZD prescriptions in this age group are considered appropriate. The most frequent inadequate situations are excessive duration and/or dosage of a medical prescription or self-medication, especially in a context where it would be contraindicated, e.g., long-acting BZD in the elderly. Polypharmacy and comorbidities are major risk factors. Consequences of BZD inappropriate use are falls, delirium and other cognitive dysfunction, acute respiratory failure, car accidents, dependence, and withdrawal symptoms. An emerging concern is a potentially increased risk of dementia. Contrary to most clinicians' belief, discontinuation of chronic BZD use in elderly patients is feasible, with adequate psychotherapeutic or pharmacological strategies, and can lead to long-term abstinence. Brief cognitive therapy mostly relies on psychoeducation and motivational enhancement and is particularly useful in this context. Further research is needed, notably in three areas: (1) assessing the impact of public health programs to prevent BZD inappropriate use in the elderly, (2) developing alternative strategies to treat anxiety and insomnia in elderly patients, and (3) exploring the association between chronic BZD use and dementia.
引用
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页数:9
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