Sedatives like diazepam and alprazolam once prescribed for treatment of anxiety or sleep could lead to one in four older adults becoming dependent on them

The use of sedatives like diazepam  or alprazolam in older adults for treatment of sleep or anxiety problems could lead to dependence in a quarter of them. These commonly prescribed sedative drugs belong to a class of drugs called benzodiazepines. The new study, published in JAMA Internal Medicine by a team of researchers from the University of Michigan, VA and University of Pennsylvania, looked at benzodiazepine use by older adults.

The study included 576 adults from the Supporting Seniors Receiving Treatment and Intervention, or SUSTAIN, service, who received their first benzodiazepine prescription from 2008 to 2016. All of the patients in the study are supported by this programme for drug and behavioral health problems. All of them live at home or in other community settings, so the study does not include patients in nursing homes and other skilled nursing facilities.

Detailed interviews were taken to screen for mental health issues including anxiety, depression, sleep issues and pain, as well as analysis of prescription records and other clinical data. The study only included people whose benzodiazepines were prescribed by non-psychiatrists or primary care physicians.

The average age of patients were 78 years when they received their first benzodiazepine prescription. Most guidelines calls for avoidance of these drugs over the age of 65 years because of increased risk of car accidents, falls, and as well as causing other side effects. Very few patients were found to have any sort of psychiatric, psychological or psychosocial care in the two years preceding the study.

“This shows that we need to help providers start with the end in mind when prescribing a benzodiazepine, by beginning with a short-duration prescription and engage patients in discussions of when to reevaluate their symptoms”

While treatment guidelines recommend only short-term prescribing, if any, these long-term patients were prescribed nearly 8 months’ worth of medication over the following year. 152 adults still had a current or recent prescription a year later. The study found older patients were four times more likely to have gone on to long-term use. Adults with longer initial prescriptions were also more likely to become long-term benzodiazepine users. For every 10 additional days of medication prescribed, a patient’s risk of long-term use nearly doubled over the next year.

“This shows that we need to help providers start with the end in mind when prescribing a benzodiazepine, by beginning with a short-duration prescription and engage patients in discussions of when to reevaluate their symptoms and begin tapering the patient off,” said Lauren Gerlach, the lead author of the study and a geriatric psychiatrist at U-M. “We also need to educate providers about effective non-pharmaceutical treatment alternatives, such as cognitive behavioral therapy, for these patients.”

The study also found that long-term users were more likely to say they had sleep problems, despite the fact that benzodiazepines are not recommended for long-term use as sleep aids and may even worsen sleep the longer they are used.

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