Is it possible to deprescribe benzodiazepine receptor agonists in older adults?

Authors

DOI:

https://doi.org/10.15448/2357-9641.2023.1.45098

Keywords:

Deprescriptions, Receptors, GABA-A, Aged

Abstract

Aim: to analyze the viability and related factors for deprescribing benzodiazepine receptor agonists (BZRA).
Methods: this is a longitudinal, prospective, interventional study performed with older adults assisted at a geriatric psychiatry outpatient clinic; these were divided into two groups: BZRA users and non-users. The instruments used in this study were a general questionnaire, the Geriatric Depression Scale (short form), the Geriatric Anxiety Inventory, and the Pittsburgh Sleep Quality Index.
Results: we evaluated 74 patients, 40 (54.1%) of which were BZRA users and 34 (45.9%) were non-users, with an average age of 71.3 ± 7.5 years. Patients who used BZRA had a higher dropout rate of the deprescription process 26 (65%). Seven patients completely stopped using BZRAs (17.5%) and five reduced their use (12.5%). The mean scores for depression and anxiety symptoms were lower at the final assessment. As to sleep quality, BZRA users presented higher baseline values and both groups presented reductions in scores at the end of the treatment.
Conclusion: deprescribing is viable and safe. However, there is resistance by both the patient and prescribers. The levels of anxiety, depression, and sleep quality improved after discontinuing BZRA.

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Author Biographies

Letícia Güenter Dannebrock, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.

MSc in Biomedical Gerontology from the Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.

Paula Engroff, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.

PhD in Biomedical Gerontology from the Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.

Vanessa Sgnaolin, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.

PhD in Biomedical Gerontology from the Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.

Isabela de Paula Bueno, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brasil.

Graduating in Biomedicine from the Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.

Alfredo Cataldo Neto, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brasil.

PhD in Medicine and Health Sciences from the Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil. Full Professor at the Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.

References

Kehler DS. Age-related disease burden as a measure of population ageing. Lancet Public Health. 2019;4(3):e123-4.

Kingston A, Robinson L, Booth H, Knapp M, Jagger C, MODEM project. Projections of multi-morbidity in the older population in England to 2035: estimates from the Population Ageing and Care Simulation (PACSim) model. Age Ageing. 2018;47(3):374-80.

Linkievicz NM, Engroff P, Cataldo A, Sgnaolin V. The process of deprescribing in older adults: a methodological protocol. Geriatr Gerontol Aging. 2022;16:e0220021.

American Geriatrics Society. American Geriatrics Society 2019 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2019;67(4):674-94.

O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2015;44(2):213-8.

Pazan F, Weiss C, Wehling M. FORTA. The EURO- -FORTA (Fit fOR The Aged) List: International consensus validation of a clinical tool for improved drug treatment in older people. Drugs Aging. 2018;35(1):61-71.

Oliveira MG, Amorim WW, Universidade Estadual do Sudoeste da Bahia, et al. Consenso brasileiro de medicamentos potencialmente inapropriados para idosos. Geriatr, Gerontol Aging. 2016;10(4):168-81.

Pottie K, Thompson W, Davies S, et al. Deprescribing benzodiazepine receptor agonists: Evidence- -based clinical practice guideline. Can Fam Physician. 2018;64(5):339-51.

Evrard P, Pétein C, Beuscart JB, Spinewine A. Barriers and enablers for deprescribing benzodiazepine receptor agonists in older adults: a systematic review of qualitative and quantitative studies using the theoretical domains framework. Implement Sci. 2022;17(1):41.

Almeida OP, Almeida SA. Short versions of the geriatric depression scale: a study of their validity for the diagnosis of a major depressive episode according to ICD-10 and DSM-IV. Int J Geriatr Psychiatry. 1999;14(10):858-65.

Pachana NA, Byrne GJ, Siddle H, Koloski N, Harley E, Arnold E. Development and validation of the geriatric anxiety inventory. Int Psychogeriatr. 2007;19(1):103-14.

Bertolazi AN, Fagondes SC, Hoff LS, et al. Validation of the Brazilian Portuguese version of the Pittsburgh sleep quality index. Sleep Med. 2011;12(1):70-5.

Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193-213.

Soyka M. Treatment of benzodiazepine dependence. Longo DL, ed. N Engl J Med. 2017;376(12):1147-57.

Brett J, Maust DT, Bouck Z, et al. Benzodiazepine use in older adults in the United States, Ontario, and Australia from 2010 to 2016. J Am Geriatr Soc. 2018;66(6):1180-5.

Brandt J, Alessi-Severini S, Singer A, Leong C. Novel measures of benzodiazepine and z-drug utilisation trends in a canadian provincial adult population (2001- 2016). J Popul Ther Clin Pharmacol. 2019;26(1):e22-e38.

Mejías-Trueba M, Fernández-Rubio B, Rodríguez-Pérez A, Bernabeu-Wittel M, Sánchez-FIdalgo S. Identification and characterisation of deprescribing tools for older patients: A scoping review. Res Social Adm Pharm. 2022;18(9):3484-91.

Markota M, Rummans TA, Bostwick JM, Lapid MI. Benzodiazepine use in older adults: dangers, management, and alternative therapies. Mayo Clin Proc. 2016;91(11):1632-9.

Airagnes G, Pelissolo A, Lavallée M, Flament M, Limosin F. Benzodiazepine misuse in the elderly: risk factors, consequences, and management. Curr Psychiatry Rep. 2016;18(10):89.

Tannenbaum C, Martin P, Tamblyn R, Benedetti A, Ahmed S. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial. JAMA Intern Med. 2014;174(6):890-8.

Niznik JD, Ferreri SP, Armistead LT, et al. Primary-Care Prescribers’ Perspectives on deprescribing opioids and benzodiazepines in older adults Drugs Aging [Internet]. 2022 Sep [cited 2023 Nov 22];39(9):739-48. Available from: https://doi.org/10.1007/s40266-022-00967-6.

Weir KR, Ailabouni NJ, Schneider CR, Hilmer SN, Reeve E. Consumer attitudes towards deprescribing: a systematic review and meta-analysis. J Gerontol A Biol Sci Med Sci. 2022;77(5):1020-34.

Vordenberg SE, Zikmund-Fisher BJ. Characteristics of older adults predict concern about stopping medications. J Am Pharm Assoc (2003). 2020;60(6):773-80.

Shilpa HSS, Kumar NN, Maheswari E, et al. Deprescribing of benzodiazepines and Z-drugs amongst the psychiatric patients of a tertiary care Hospital. Asian J Psychiatr. 2019;44:189-94.

Onder G, Vetrano DL, Villani ER, et al. deprescribing in nursing home residents on polypharmacy: incidence and associated factors. J Am Med Dir Assoc. 2019;20(9):1116-20.

Reeve E, Ong M, Wu A, Jansen J, Petrovic M, Gnjidic D. A systematic review of interventions to deprescribe benzodiazepines and other hypnotics among older people. Eur J Clin Pharmacol. 2017;73(8):927-35.

Carr F, Tian P, Chow J, et al. Deprescribing benzodiazepines among hospitalised older adults: quality improvement initiative. BMJ Open Qual. 2019;8(3):e000539.

Oldenhof E, Mason T, Anderson-Wurf J, Staiger PK. Role of the prescriber in supporting patients to discontinue benzodiazepines: a qualitative study. Br J Gen Pract. 2021;71(708):e517-27.

Haigh EAP, Bogucki OE, Sigmon ST, Blazer DG. Depression among older adults: a 20-year update on five common myths and misconceptions. Am J Geriatr Psychiatry. 2018;26(1):107-22.

Ramos K, Stanley MA. anxiety disorders in late life. Clin Geriatr Med. 2020;36(2):237-46.

Dafsari FS, Jessen F. Late life depression – diagnosis, pathophysiology and therapeutic strategies. Fortschr Neurol Psychiatr. 2018;86(4):242-55.

Moreno RA, Cordás TA. Condutas em psiquiatria: consulta rápida. Porto Alegre, Artmed Editora; 2017. 444 p.

Gulia KK, Kumar VM. Sleep disorders in the elderly: a growing challenge. Psychogeriatrics. 2018;18(3):155-65.

Walther BW. Gestörter schlaf im alter: mit einfachen Mitteln abklärbar! MMW - Fortschritte der Medizin. 2019;161(13):42-6.

Feinsilver SH. Normal and abnormal sleep in the elderly. Clin Geriatr Med. 2021;37(3):377-86.

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Published

2023-12-04

How to Cite

Güenter Dannebrock, L., Engroff, P., Sgnaolin, V., de Paula Bueno, I., & Cataldo Neto, A. (2023). Is it possible to deprescribe benzodiazepine receptor agonists in older adults?. PAJAR - Pan American Journal of Aging Research, 11(1), e45098. https://doi.org/10.15448/2357-9641.2023.1.45098

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Vol. 11 No. 1 (2023): Single Volume - Continuous Flow of Publication

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Original Article

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