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Older People and benzodiazepine use and dependence Gwenda Cannard What do we mean by “old”? Influence of stereotypes on prescribing “What do you expect at your age?” “One foot in the grave & the other on a banana skin” Psychological distress and older people –self report

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Presentation Transcript
influence of stereotypes on prescribing
Influence of stereotypes on prescribing
  • “What do you expect at your age?”
  • “One foot in the grave & the other on a banana skin”

TRANX 2005

psychological distress and older people self report
Psychological distress and older people–self report
  • Self reports of psychological distress lessen with age
  • 13% of the adult population reported high to very high levels c/f 9% older people
  • 1997 Survey 18% of adult population reported having a mental health problem c/f 6% of older people

National Health Survey 2001

Study of Mental Health & Wellbeing 1997

TRANX 2005

2001 national health survey
2001 National health survey
  • 18% of the population taking some medication (including vitamins & minerals) for mental health problems
  • 4.7% antidepressants
  • 4.1% sleeping tablets
  • 1.9% tablets for anxiety or “nerves”
  • 0.7% tranquillisers
  • The majority had been taking medication for 6 months or more

TRANX 2005

older people and medication
Older people

37% sleeping tablets

15% antidepressants

Adult population

4% sleeping tablets

5% antidepressants

Older people and medication

TRANX 2005

benzodiazepines and older people
Benzodiazepines and older people
  • Usually prescribed for sleep
  • 10% of males and 16% of females aged 75 and over use sleeping pills
  • c/f 3% of males and 5% of females for the adult population

TRANX 2005

effects of benzodiazepines for older people
Effects of benzodiazepines for older people
  • Over sedation
  • Falls and hip fractures
  • Impaired blood pressure regulation
  • Cognitive impairment & memory loss
  • Nocturnal urinary incontinence
  • Emotional changes- worsening depression
  • Worsening sleep
  • Respiratory problems

TRANX 2005

sleep problems and older people
Usually related to circadian rhythm changes

Quality of sleep changes as we age- less time in the deep sleep phase and REM

May relate more to daytime activities

Myth of “needing less sleep”

Sleep problems and older people

TRANX 2005

sleep problems for older people
Sleep problems for older people
  • Need to be addressed appropriately –not dismissed

TRANX 2005

benzodiazepine withdrawal
Benzodiazepine withdrawal
  • Wide range of distressing symptoms
  • Anxiety and insomnia are common withdrawal symptoms –often the presenting problem
  • Can be protracted – weeks or months

TRANX 2005

common withdrawal symptoms
Common withdrawal symptoms
  • Anxiety & panic attacks
  • Insomnia
  • Heightened sensitivity of the senses
  • Muscle twitching and spasm
  • Pins and needles
  • Nausea
  • Dizziness
  • Depression
  • Loss of memory
  • Loss of appetite
  • Hallucinations

TRANX 2005

older people and benzodiazepine reduction
Older people and benzodiazepine reduction?
  • How old is “too old”?
  • Studies have shown no difference between success of older and younger people in ability to reduce benzodiazepine use.

TRANX 2005