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The real life of benzodiazepines in geriatric department : what about the patient ?

European Statement

Clinical Pharmacy Services

Why was it done?

Benzodiazepines and derivatives (BZD) are often prescribed over a long time period among the elderly for anti-anxiety and hypnotic purposes leading the eldery to become addicted to their treatment. However, on the long term, BZD are less effectives and may cause dependence and adverse effects (AE). It is necessary to reassess the treatment to avoid them.

What was done?

This study evaluates patients’ dependence on BZD and reassesses the treatment after explaining the AE to patients.

How was it done?

A questionnaire for patients taking BZD at home, were developed: at first, the questions were about the reason of hospitalization, BZD’s indications, initiation date, occurrence of AE and attempts to stop treatment.

Then, the ECAB dependence test (cognitive scale of attachment to BZD) was proposed.

Eventually, explanations about BZD long term AE and an information sheet were given to patients. A substitution with short half-life BZD, dosage reduction or treatment discontinuation was proposed to the patient in collaboration with the geriatrician.

What has been achieved?

The questionnaire was completed by 34 patients. Of these patients, 44.1% came for falls and/or confusions, 27 had one BZD at home and 7 had two. About the prescribed BZD, 80.5% were for hypnotic purpose, 19.5% for anti-anxiety purpose, and 9.8% had long half-lives (not recommended for elderly).

Of 41 BZD, 46.3% had been prescribed for over 10 years.

Amid the patients, 79.4% reported AE, including 21 fall cases, 11 confusion cases and 7 somnolence cases.

Only 13 patients tried to stop the treatment.

There are 18 patients with an ECAB score greater than or equal to 6 which indicates that they are dependent on BZD (sensitivity: 94%; specificity: 81%).

Eventually, after presenting BZD AE, 6 patients switched to a BZD with shorter half-life, 10 agreed dosage reduction and 4 agreed stopping the treatment. In total, a positive result was obtained in 58.8%.

What next?

BZD are still widely prescribed and very few are re-evaluated despite the risk of AE among the elderly (often poly-pathological and poly-medicated). Given the positive results after providing an information sheet on BZD AE, it would be interesting to extend this practice to the entire hospital.

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