The other drugs that should concern senior living

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Photo by Raija Törrönen
Photo by Raija Törrönen

People with diagnosed Alzheimer's disease are more than three times more likely to be prescribed a benzodiazepine or related drug than those in whom the disease has not been diagnosed, according to a study by the University of Eastern Finland in press for the Journal of Alzheimer's Disease.

The researchers also found that the drugs often are prescribed even before someone receives a diagnosis of Alzheimer's and that use of the drugs becomes even more common after a diagnosis.

“Benzodiazepines and related drugs are occasionally used to treat certain symptoms of Alzheimer's disease,” such as sleep or anxiety issues, the researchers write. “However, the risks related to [these drugs'] use are high in older persons.”

Why should Americans care about prescribing and use patterns related to benzodiazepines in Finland? It turns out that the drugs appear to be inappropriately prescribed in the United States, too, according to research published earlier this year in JAMA Psychiatry. And that's worrisome, one of the authors of the U.S. research told McKnight's Senior Living, because overuse of benzodiazepines in older adults can lead to falls and other accidents as well as difficulty in quitting the drugs.

Mark Olfson, M.D., M.P.H., of Columbia University, Marissa King, Ph.D., of Yale University and Michael Schoenbaum, Ph.D., of the National Institute of Mental Health recently published research about the use of antipsychotic medications in older adults, but Schoenbaum said the use of benzodiazepines in this population is even more common.

“There's not the same FDA black box warning on benzodiazepines [as with antipsychotics], but what we observed, in short, is that the fraction of adults using benzodiazepines rose with age across the entire life course, and it was especially high in women,” he said. “And because [use] rose with age, it was especially high in older women.”

In fact, analyzing data from 2008, Schoenbaum and the other authors found that, among adults aged 65 to 80 years, 6.1% of men and 10.8% of women had used benzodiazepines in the past year, and the highest rate of use, 11.9%, was by 80-year-old women. These rates of use “are higher than it seems they should be,” Schoenbaum said.

“These are drugs that are commonly prescribed for anxiety,” he added, “but they are drugs about which there's also a lot of reason to worry about overuse. And they are dangerous because they interfere with balance, in particular, so they make people susceptible to falls and car accidents, and they contribute to confusion and other kinds of cognitive impairments.”

And unlike antipsychotic medications, Schoenbaum said, benzodiazepines are habituating, meaning it's “very difficult” for people to quit taking them. “If you give them to someone for more than short-term use—people use them over months or years as opposed to days or weeks—what happens fairly quickly is that they stop being therapeutic and people take them mostly to prevent the symptoms of withdrawing from them,” he added.

The findings of the JAMA Psychiatry paper prompted a commentary in the same issue of the journal (February 2015), wherein Nicholas Moore, M.D., Ph.D., Antoine Pariente, M.D., Ph.D., and Bernard Bégaud, M.D., Ph.D., suggested that only psychiatrists be allowed to prescribe benzodiazepines and that the drugs should be treated like controlled substances, with duration of prescriptions limited and no refills allowed.

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