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Benzodiazepine Use in Older Patients Criticized

Nursing homes have come under fire in recent years for the widespread use of antipsychotic drugs among elderly patients with dementia, as many centers use the drugs to quell outbursts and aggression, while ignoring the many potentially serious health risks to the patient.

Now, there is cause for concern among elderly patients regarding another type of drug: Benzodiazepines. These medications are typically prescribed for insomnia or anxiety. However, new research reveals that while these medications are more widely prescribed than previously thought, they may pose particular danger for older patients. Specifically for those in nursing homes, they may contribute to falls and fractures and reduced cognition.

A recent study by the Journal American Medical Association Psychiatry, nearly 9 percent of Americans between the ages of 65 and 80 are prescribed at least one type of benzodiazepines. These sedative-hypnotic drugs can include Klonopin, Xanax, Valium or Ativan. For older women, the rate of prescription is 11 percent.

Top advisers for the national Institutes of Mental Health call that rate of usage “extraordinarily high,” especially considering what we know about the dangers of benzodiazepine use in older adults. There have been many decades of research on the subject. For example, a 2005 study published in the journal BMJ indicated that while there were improvements in sleeping disorders among older adults who took these kinds of drugs, the increased risk of cognitive impairment, falls and overall psychomotor skills would likely render the drug too dangerous for most of those over age 60.

Overuse of the drugs in nursing homes especially was first addressed in the federal nursing home reform law in 1987. And yet, we have continued to see it crop up – in the 2013 report “Choosing Wisely list of questionable practices” by the American Geriatrics Society and in the 2014 study in BMJ linking use of the drugs with Alzheimer’s disease.

When the American Geriatrics Society in 2012 issued an updated list of medications with potentially harmful effects to older adults, the agency strongly advised doctors to steer clear of prescribing benzodiazepines for treatment of delirium, agitation or insomnia. The organization rated its quality of evidence on the issue high.

Yet despite this clear warning, a follow-up analysis of prescriptions at retail pharmacies indicated that in 60 percent of those locations, demand for benzodiazepan increased, particularly for those over the age of 65. And while most people – regardless of age – are only supposed to take these drugs for a few weeks at the most, those in the older age cohort had consumed the drug for 120 days or more. In some cases, individuals had been on the drug for 10 years or more.

Part of the reason for the uptick is the fact that these drugs are effective in improving sleep habits and a brief respite from anxiety. This is especially important for older adults, who are often averse to therapy.

But the drugs are also highly addictive. Plus, it’s not clear whether the drugs provide any long-term therapeutic benefit.

It may be easier for doctors treating patients in a nursing home setting to simply dole out the easiest immediate solution for patients with anxiety and insomnia – and the staffers who treat them. But just as antipsychotic drugs are accompanied by a host of dangerous side effects, the long-term use of benzodiazepines may not be in the best interest of the patient.

Close family members would be wise to raise this issue with nursing home staff and doctors if they have concerns. Nursing home negligence lawyers are also available to answer questions regarding potential prescription errors among nursing home residents resulting in injury or death.

Freeman Injury Law — 1-800-561-7777 for a free appointment to discuss your rights.

Additional Resources:

Continued Questions on Benzodiazepine Use in Older Patients, Feb. 13, 2015, By Paula Span, The New York Times

More Blog Entries:

Nursing Home Staff Overtime Has Potential for Neglect, Feb. 7, 2015, Broward County Nursing Home Abuse Lawyer Blog

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