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Benzodiazepine Prescribing in Older Adults

Benzodiazepine Prescribing in Older Adults

Benzodiazepines can effectively treat anxiety, agitation, insomnia, and alcohol withdrawal, but their use in older adults has been linked to higher adverse event rates. These drugs can also become habit-forming, making it difficult to discontinue them after years of use. “Benzodiazepines are effective drugs for many ailments, but they may not be the best option for older adults,” says Erin M. Marra, MD. Recent studies of older adults show that these agents can increase risks for falls, hip fractures, memory problems, delirium, daytime drowsiness, and motor vehicle crashes when compared with younger people. Despite these safety concerns, benzodiazepines are still commonly prescribed in older adults. Some studies estimate that 10% to 25% of people aged 65 and older are using benzodiazepines. Several guidelines, such as the Beers criteria and the Screening Tool of Older Persons’ Prescriptions criteria, have been issued to reduce prescribing of these drugs to older adults. Few studies, however, have examined benzodiazepine prescribing trends in in ambulatory clinics and EDs in the United States.   Analyzing Trends For a retrospective study published in the Journal of the American Geriatrics Society, Dr. Marra and colleagues assessed data on ambulatory clinics and EDs from 2001 to 2010 using the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. The investigators analyzed encounters involving people aged 65 and older for whom a benzodiazepine might be prescribed and explored trends in benzodiazepine use in these visits. They hypothesized that benzodiazepine prescribing rates would be lower in both ambulatory clinics and EDs in light of recent guideline recommendations. According to the results, benzodiazepines were used in 16.6 million...

Guidelines for Managing Agitated Patients in the ED

Proper management of agitated patients presenting to the ED is essential to keeping staff safe and ensuring appropriate care. In many cases, agitation cases can be managed with non-pharmacologic methods, but medications are becoming increasingly important in acute agitation in EDs. In the February 2012 Western Journal of Emergency Medicine, my colleagues and I at the American Association for Emergency Psychiatry published consensus recommendations on best practices for using medication to manage agitated patients in emergency settings. Rationale & Goals When Calming Patients Non-pharmacologic approaches—verbal de-escalation, quieting the room, and dimming the lighting—should be attempted before medications are administered. When initial verbal methods fail to calm patients, medication may be necessary. Clinicians should make a provisional diagnosis on the likely cause of the agitation because this can help guide medication choices. In many cases, agitation increases over time during ED treatment. By intervening early, to preempt the potential escalation of agitation to severe and dangerous levels, it may be possible to include patients in the medication decision process and use lower doses. The goal of using medication in agitated patients is to calm them without inducing sleep. Excessive sedation may interfere with assessment and treatment of underlying conditions. To the extent possible, medications should be used that specifically target the cause of agitation based on the provisional diagnosis. “The goal of using medication in agitated patients is to calm them without inducing sleep.” No class of medication is considered “best” in all cases of agitation, but three drug classes have been studied and used most frequently, including first- and second-generation antipsychotics and benzodiazepines. Although these drugs may manage acute...
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