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Older People and benzodiazepine use and dependence

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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Older People and benzodiazepine use and dependence

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  1. Older People and benzodiazepine use and dependence Gwenda Cannard TRANX 2005

  2. What do we mean by “old”? TRANX 2005

  3. 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

  4. 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

  5. Levels of psychological distress TRANX 2005

  6. 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

  7. Older people 37% sleeping tablets 15% antidepressants Adult population 4% sleeping tablets 5% antidepressants Older people and medication TRANX 2005

  8. 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

  9. 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

  10. Anxiety and benzodiazepines and benzodiazepines and anxiety TRANX 2005

  11. 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

  12. Sleep problems for older people • Need to be addressed appropriately –not dismissed TRANX 2005

  13. 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

  14. 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

  15. 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

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