In
contrast to my mostly homebound senior clients, I’m usually out and about so
I’ve often considered taking a 30-day challenge to live like a shut-in so I
could experience life like my clients.
As an introvert, I am inspired by shut-in clients who engage in creative
arts like writing and publishing poetry, painting and selling artworks online, composing and
performing music, etc.
LAE staff
attorneys – Judy Hitchcock (elder abuse prevention; also Spanish bilingual),
Christine Lau (public benefits; also Cantonese bilingual), Tom Drohan (housing;
also bass player with The Shut-Ins) – have been with LAE for about 25 years
each! Paralegal Christy Nieves brought
age diversity (and Spanish bilingual skills) after Bessie (who joined LAE in 1980 shortly after its founding) retired last year.
Volunteer
receptionist Tom Tallman (sandwiched between friend Richard and LAE Director
Howard Levy, in photo above) has been with LAE for more than 25 years!
Howard
presented long-time LAE volunteer paralegal Sandra Fenix (Portuguese bilingual)
with Volunteer Award.
Howard
announced his retirement by year-end after 28 years as LAE’s Executive
Director. Howard’s legacy is his role in
fostering employee and volunteer retention (aging in workplace!), which seems
remarkable for a non-profit serving older adults in San Francisco
LAE Board
(not bored) member and journalist Tim Redmond noted
that 14% of eviction defense cases in San
Francisco
Get up
and dance to music of The Shut-Ins!
Mental health
Department
of Aging & Adult Services (DAAS) Education Coordinator Rick Appleby
introduced presenters at DAAS Community Training on
Mental Health in Older Adults. None of the presenters
were psychiatrists, but it was refreshing to
hear two geriatricians take a holistic (mind+body) approach rather than focus
only on internal medicine diseases of older adults.
- Female
- Social isolation or
low contact with friends or low quality relationships
- Widowed, divorced,
separated marital status
- Lower socioeconomic
class
- Comorbid medical
conditions or worsening physical health
Dr. Chen shared screening tools for depression (PHQ-9),
suicidality (P4),
and loneliness (De Jong Gierveld 6-item). Her recommendations: ask about
mood/loneliness, be present and encourage interactions, connect with
community resources.
While my shut-in clients seem receptive to contacting Friendship Line or
friendly visitor programs, they are sometimes reluctant to seek services of mental health
professionals due to stigma.
Anna Chodos, MD, UCSF Division of Geriatrics, presented on Substance
Abuse, a cohort issue with higher lifetime prevalence among baby boomers
age 60-64. She also noted that 25% of older adults use psycho-active prescription drugs with potential for misuse/abuse:
- Opiates: morphine, oxycodone,
methadone; 40-50% older adults in chronic pain
- Benzodiazepine: lorazepam,
diazepam, etc.; avoid in older adults as these may cause decreased
attention, memory, cognitive function, motor coordination lead to
increased risk of falls/car crashes
- Medical marijuana:
controversial (risk/benefit not clear); used for neuropathy, glaucoma,
pain, anxiety
Screening for substance use disorders include TWEAK for alcohol use, and DAST-10 for other substance use.
Tobacco is
the most common substance used by my clients.
As much as I want to support aging in place, there have been days when
I’d come home smelling like an ashtray after home visits with clients who
smoked like chimneys, and I’d think I’d be better off in a non-smoking
institution like a nursing home!
Sonya Maeck, LCSW, Clinical Administrator and Program Director at Jewish
Home, discussed her facility’s 12-bed acute geriatric psychiatry hospital that exclusively serves older adults who require short-term treatment (average
18-day stay) for psychiatric conditions like anxiety, depression, suicidal
thoughts, etc. Its staff has specialized
training in the unique medical and psychiatric needs of older adults to
evaluate physical conditions (e.g., infection) that can be underlying factors
in mental disorders; after successful treatment, the goal is for the senior to
return home.
Encourage interaction
My work with
shut-ins is rewarding with opportunities to make a difference and the mutual
appreciation for home visits. While I wish
I had more time with clients, I have a fairly tight schedule of 5 to 6 home
visits per day plus travel time. I often
politely redirect clients who use
questions to seque into long stories.
(See The Onion video report, “Census Visits Providing Shut-Ins Once-A-Decade Chance For Human Interaction,” featuring 87-year-old Helen DeAngelis who gives tips for trapping a census
worker in your home for as long as possible.)
For example, when I asked one client about her mobility, she
replied that she used a cane to ambulate, and then she proceeded to recount her
delightful story about getting the carpet in her studio apartment shampooed, which
required her to leave home for 6 hours, so she took this opportunity to explore
her neighborhood, which included visiting library to get a library card, then
went to the movie theatre, etc. Being out and about improved her disposition.
One way to
reduce isolation of shut-ins is to fix broken doorbells, especially those who live
in houses with outer gates preceding front doors so visitors need to ring
doorbell or telephone: ding-dong-ding, how else can Jehovah’s Witnesses go door-to-door and reach
isolated seniors who might welcome free home Bible studies?
Advance care planning
- Sarah
Hooper, Executive Director of the UCSF/UC Hastings Consortium on Law,
Science & Health Policy, talked about how the process of documenting
one’s legacy (in the form of advance health care directives, power of
attorney for finance, wills, etc.) is empowering because law students care to ask and listen to clients
about their goals and wishes, which are given the force of law—yet
emphasizing the conversations are more important than the forms.
- Eric
Widera, Clinician-Educator at UCSF Geriatrics, said “ditto” adding though it’s hard to predict future situations,
conversations focus on what are important values—some people are known to
appoint their bartender, who is someone they trust, they can have
conversation and who is available to serve.
- Stefanie
Elkins, California Medical Outreach Manager at Compassion & Choices,
discussed California End of Life Option Act,
which became effective June 9, 2016, authorizing medical aid in dying.
Because I have shut-in clients who cycle in and
out of hospice care, I wonder about California End of Life Option Act applying
to terminally ill adults with a “prognosis of six months or less to live” when
it is difficult to predict when someone will die.
‘America’s other drug problem’: Giving the elderly too many prescriptions
ReplyDeleteBy Anna Gorman
August 15
…An increasing number of elderly patients nationwide are on multiple medications to treat chronic diseases, raising their chances of dangerous drug interactions and serious side effects. Often the drugs are prescribed by different specialists who don’t communicate with each other. If those patients are hospitalized, doctors making the rounds add to the list — and some of the drugs they prescribe may be unnecessary or unsuitable.
“This is America’s other drug problem — polypharmacy,” said Maristela Garcia, director of the inpatient geriatric unit at UCLA Medical Center in Santa Monica, Calif…
Some drugs can cause confusion, falling, excessive bleeding, low blood pressure and respiratory complications in older patients.
Older adults account for about 35 percent of all hospital stays but more than half of the visits that are marred by drug-related complications, according to a 2014 action plan by the Department of Health and Human Services. Such complications add about three days to the average stay…
…Institute of Medicine determined in 2006 that at least 400,000 preventable “adverse drug events” occur each year in American hospitals. Such events, which can result from the wrong prescription or the wrong dosage, push health-care costs up annually by about $3.5 billion (in 2006 dollars).
Even if a drug doesn’t cause an adverse reaction, that doesn’t mean the patient needs it. A study of Veterans Affairs hospitals showed that 44 percent of frail elderly patients were given at least one unnecessary drug at discharge.
…Ken Covinsky, a researcher and physician at the University of California at San Francisco, said many doctors who prescribe drugs in hospitals don’t consider how long those medications might be needed. “There’s a tendency in medicine every time we start a medicine to never stop it,”…
When doctors in the hospital change or add to the list of medications, patients often return home uncertain about what to take. If patients have dementia or are unclear about their medications and they don’t have a family member or a caregiver to help, the consequences can be disastrous.
A 2013 study found that nearly a fifth of patients discharged from the hospital had prescription-related medical complications during their first 45 days at home. About 35 percent of those complications were preventable, and 5 percent were life-threatening.
UCLA hired Bailey about three years ago. The idea was to bring a pharmacist into the geriatric unit to improve care and reduce re¬admissions.
…Having a pharmacist on a team caring for older patients can reduce drug complications and hospitalizations, according to a 2013 analysis published in the Journal of the American Geriatrics Society.
…many drugs act differently in older patients than in younger ones.
…determine what’s best for a patient. Is the drug needed? Is the dose right? Is it going to cause a problem?
One of his go-to references is known as the Beers list, a compilation of medications that are potentially harmful for older patients. The list, named for the doctor who created it and produced by the American Geriatrics Society, includes dozens of medications, including some antidepressants and antipsychotics.
When he’s not talking to doctors at the hospital, Bailey is often on the line with other pharmacists, physicians and relatives to make sure his patients’ medication lists are accurate and up-to-date. He also monitors patients’ new drugs, counsels patients about their prescriptions before they are discharged and calls them afterward to make sure they are taking the medications properly.
“Medications only work if you take them,” Bailey said dryly…
“It is figuring out what they need,” he said, “versus what they can survive without.”
https://www.washingtonpost.com/national/health-science/americas-other-drug-problem-giving-the-elderly-too-many-prescriptions/2016/08/15/e406843a-4d17-11e6-a7d8-13d06b37f256_story.html
Reviving House Calls by Doctors
ReplyDeleteTina Rosenberg
SEPT. 27, 2016
…Before 1950, nearly half of all doctors’ visits in America were house calls. But then the country began building big hospitals and luxurious doctors’ offices, and doctors acquired sophisticated equipment they couldn’t put in a medical bag. Medicare and Medicaid reimbursement systems made home visits untenable.
But the house call is now a better idea than ever.
To cut America’s health care costs, it helps to look at the most expensive patients. Medicare spends a third of its budget caring for chronically ill people in their last two years of life. This group is growing fast, and growth will accelerate; the first baby boomers are now turning 70.
The expense largely comes from hospitalizations, at an average cost of $12,000. So whatever keeps these patients out of the hospital (or out of expensive nursing homes) will save money — and also, of course, greatly improve the patient’s quality of life.
For a frail elderly person, going to a doctor may mean that a relative takes a half-day off from work. An ambulette must be hired. The wheelchair may not fit in the doctor’s office. As a result, old people often don’t get routine care — and eventually land in the emergency room.
House calls provide that care. One study from 2014 found that for frail elderly people, house calls saved Medicare $4,200 per person per year.
…For house calls to spread, they must be feasible in a fee-for-service universe.
That’s the purpose of Independence at Home, an experiment of the federal Center for Medicare and Medicaid Services. (It’s one of numerous Obamacare experiments in paying for quality of care, not quantity.) Independence worked with 15 medical practices to give them part of the money saved by house calls. Over all, it has saved Medicare $25 million in its first year and $10 million in its second. (A bill in the Senate would make the program permanent.)
…A home visit can be better medicine in other ways as well…“You can see hazards in the house. What the refrigerator is filled with. What the pill bottles are filled with — or not.
“Patients in their own environment are far more relaxed and forthcoming with meaningful information,” he said. “You get a lot closer to the reality of the situation, and you spend the time.”
De Jonge argues that seeing a patient at home is crucial for understanding her important nonmedical needs, and getting her the right social support and daily personal help. A study of the Mount Sinai Visiting Doctors Program in New York, for example, found that it reduced patients’ pain, anxiety, depression and fatigue.
Time is another advantage. House calls eliminate no-shows…
…Doctors Making House Calls contracts with companies to bring X-ray machines or phlebotomists to patient’s homes. “The only thing we can’t do is a CT scan or M.R.I.,” said Taavoni. “But neither can doctors’ offices.”
For some patients, especially those with dementia, going to the doctor — or far worse, the hospital — is itself a medical issue. They can get disoriented and upset. …And, of course, hospitals and doctors’ offices harbor germs especially dangerous to someone frail. House calls solve these problems…
http://www.nytimes.com/2016/09/27/opinion/reviving-house-calls-by-doctors.html
As house calls make a comeback, doctors need to learn new skills
ReplyDeleteBy JUNE M. MCKOY and KATHERINE T. O'BRIEN
DECEMBER 7, 2016
When Donald Trump takes the oath of office in January, he will be the oldest president Americans have ever elected. That also makes him some doctor’s geriatric patient, joining 46 million Americans in the age 65 and older group. By 2060, that number will double, reaching a staggering 98 million people. Taking care of older patients can be a challenge. Some have multiple health conditions, and many are homebound, making a trip to see their primary care doctor almost impossible.
House calls will almost certainly become a way to improve the care of our geriatric patients and will become an essential piece of the provision of care in the future. In fact, legislation being discussed in Congress would help make home-based medical care a financial reality.
Making house calls sounds simple. But we worry that physicians-in-training aren’t learning the skills they need to care for their patients at home.
The American Board of Internal Medicine and the Council of Academic Family Medicine, two bodies that help certify doctors in fields likely to provide home care, have lists of procedures that they deem essential to the independent practice of their respective fields. The list for internal medicine graduates is surprisingly short, with knowledge of how to draw blood, insert a needle into a vein, and do a pap smear on a woman as the only essential skills required. The list for family medicine graduates is slightly longer, including some basic women’s health and obstetric skills. Glaringly missing are the procedural skills needed to provide quality, and arguably, crucial care to patients at home. These include management of urinary tubes, feeding tubes, breathing tubes, chest tubes, infected wounds and sores, and more.
Today’s — and undoubtedly tomorrow’s — medical technology makes it possible for patients with multiple medical conditions, such as diabetes and heart failure, to thrive in their own homes and be treated there. That means the scope of knowledge and technical skills required for a home care doctor has become increasingly complex.
When doing a house call, a doctor does not have the luxury of sending his or her patient to a specialist for immediate attention. The patient may be on a breathing machine or ventilator with a tracheostomy tube that needs to be changed. He or she may have a feeding tube that malfunctions, or arthritis so bad that an injection of steroid into a joint is needed.
In the past, such procedures were familiar to most young physicians in all fields of medicine largely because there had been a generalist, competency-based approach to medical education. However, as the scope of medicine has widened, those in today’s training programs often forego mastery of these basic procedural skills in favor of procedure-oriented services, such as interventional radiology. Young doctors must then rely on simulation centers or shadow specialty doctors to gain the out-of-hospital skills they weren’t able to master during their training.
If the house call is to truly make a comeback — and it should for both patient convenience and cost — training programs and the organizations that oversee them must revolutionize their curricula to help young physicians develop the skills necessary for home care medicine.
…It might even be necessary for interns and residents to do three to six months of extra training to really master the complexities of taking care of patients at home.
Home visits can be an effective way of providing medical care to the burgeoning senior population in the US. But making home care a reality will require training programs to provide future doctors with the skills to provide proper home care…
https://www.statnews.com/2016/12/07/doctors-house-calls-medicine/
Opioids Can Derail The Lives Of Older People, Too
ReplyDeleteDecember 20, 2016
…As the nation grapples with a devastating opioid epidemic, concerns have primarily focused on young people buying drugs on the street. But many elderly people in America also have a drug problem. Over the past several decades, physicians have increasingly prescribed older patients medication to address chronic pain from arthritis, cancer, neurological diseases and other illnesses that become more common in later life. And sometimes those opioids hurt more than they help.
A recent study of Medicare recipients found that in 2011, about 15 percent were prescribed an opioid when they were discharged from the hospital; three months later, 42 percent were still taking the pain medicine.
…In 2009, the American Geriatric Society came out strongly in favor of opioids,updating its guidelines on pain management to urge doctors to consider using opioids for older patients who have moderate to severe pain. The panel cited evidence that seniors were less likely than others to become addicted.
Dr. Bruce Ferrell, a geriatrician and pain specialist at the University of California, Los Angeles, served as chairman of the panel that issued the AGS guidelines.
"You don't see people in this age group stealing a car to get their next dose," Ferrell told The New York Times at the time.
Dr. Mel Pohl, medical director of the Las Vegas Recovery Center, calls that conclusion a "horrible misconception."
"There's no factual, scientific basis for that," he says. "The drug takes over in the brain. It doesn't matter how old the brain is."
The problem is that there aren't many good options to treat chronic pain as people age. Even aspirin and ibuprofen carry bleeding risks that can be serious.
The 2009 AGS guidelines are no longer in use, but opioid medications remain a crucial tool to treat pain in older people. And most people are able to take opioids in small doses for short periods of time without a problem.
"We really don't use opioids necessarily as the first line of treatment, because we understand what the risks are," says Dr. Sharon Brangman, past president of the AGS. "But we also don't want to see our patients suffering needlessly if we can provide them with relief." The trick, she said, is to first try non-pharmacological options such as acupuncture, and to use the smallest effective opioid dose possible.
Nonetheless, in the past 20 years, the rate of hospitalization among seniors that is related to opioid overuse has quintupled.
It took John Evard about a week to get over the vomiting and flulike symptoms of detox, which can be particularly hard on older patients. He still has some of the chronic pain that first led him to seek help from a doctor, he says, but he takes Tylenol to deal with it. He's speaking out now about opioids because he doesn't want other seniors to fall into the same trap.
"Don't just take the prescription because it's part of the checkout process from the hospital," he cautions. "It's your body. Take charge of it, and push for alternatives at all costs. And if you do go on, get off them as fast as you can."
http://www.npr.org/sections/health-shots/2016/12/20/502470255/opioids-can-derail-the-lives-of-older-people-too
The Top Drugs for Older Adults to Avoid
ReplyDeleteLearn which medications are on pharmacists’ ‘black list’
November 22, 2016
By Patricia Corrigan
…Two pharmacists say the aging process is to blame, and they reveal here the names of medications on their “black list” that older adults may want to avoid.
“Prescribing medications for people 65 and older can be more challenging, because some drugs can be more toxic or cause more side effects than when you were younger,” says Kirby Lee, a pharmacist and associate professor of clinical pharmacy at the University of California at San Francisco. “As your body ages, it absorbs medications differently. They can be metabolized differently by your liver and excreted differently by your kidneys, so you may be more sensitive to some medications.”
…Here are six classes of medications considered especially problematic for older adults:
1. Benzodiazepines Prescribed — often over-prescribed — for anxiety and sleep disorders, this class of drugs includes diazepam (Valium), lorazepam (Ativan), alpraxolam (Xanax) and chlordiazepoxide (Librium). The medications can cause confusion and greatly increase the risk of falling.
2. Non-Benzodiazepines Prescribed for insomnia, Zolpidem (Ambien), zaleplon (Sonata) and eszopiclone (Lunesta) are highly addictive and also can cause bizarre sleep behaviors, including sleepwalking.
3. Anticholinergics Diphenhydramine (Benadryl), acetaminophen with diphenhydramine (Tylenol PM) and some muscle relaxants that contain diphenhydramine (an antihistamine) can cause confusion, constipation, dry mouth, blurry vision or urine retention in older adults. Cumulative exposure to these drugs can lead to dementia.
4. Nonsteroidal anti-inflammatory drugs Ibuprofen (Motrin), naproxen (Aleve), aspirin and other drugs in this class are “tough on kidneys,” Lee says, and increase the possibility of stomach bleeds. They are not recommended for long-term use. For management of arthritis pain, Lee recommends acetaminophen (Tylenol), physical therapy, acupuncture, aquatic therapy or acupressure.
5. Antipsychotics This class of drugs is useful to treat significant psychosis or serious mental health conditions, but is too often prescribed for mild agitation, anxiety or depression. Lee suggests taking the lowest effective dose for the shortest term possible. “People get started on these and then they don’t top,” he says.
6. Old drugs Though barbiturates are rarely prescribed any longer, these sedatives are still available and are highly addictive both physically and psychologically.
Worz notes that blood pressure medications also can cause fatigue or lead to falls.
And he suggests being cautious with the dosage for ranitidine (Zantac), often taken for heartburn. “Taking 150mg twice daily is a normal dose, but in an older person, kidney function may no longer be sufficient to eliminate the drug quickly.” That can lead to possible cognitive issues that can look like dementia.
“Nobody should have to live with a problem that is the result of taking a drug,” Worz adds. “Your doctor or pharmacist usually can find better drugs with fewer side effects to help you.”
For information about other medications that may cause problems for older adults, Worz recommends the “Beers List,” named for the physician who first published the list, which is updated periodically by the American Geriatrics Society.
http://www.nextavenue.org/unexpected-drug-side-effects-familiar-drugs-older-adults/
Breaking the Stigma — A Physician’s Perspective on Self-Care and Recovery
ReplyDeleteAdam B. Hill, M.D.
N Engl J Med 2017; 376:1103-1105 March 23, 2017
My name is Adam. I am a human being, a husband, a father, a pediatric palliative care physician, and an associate residency director. I have a history of depression and suicidal ideation and am a recovering alcoholic. …I am a survivor of an ongoing national epidemic of neglect of physicians’ mental health.
In the past year, two of my colleagues have died from suicide after struggling with mental health conditions. On my own recovery journey, I have often felt branded, tarnished, and broken in a system that still embroiders a scarlet letter on the chest of anyone with a mental health condition.
…I could no longer sit by and watch friends and colleagues suffer in silence. I wanted to let my suffering colleagues know they are not alone. I delivered a grand-rounds lecture to 200 people at my hospital, telling my own story of addiction, depression, and recovery. …A floodgate of human connection opened up. I had been living in fear, ashamed of my own mental health history. When I embraced my own vulnerability, I found that many others also want to be heard — enough of us to start a cultural revolution.
My years of recovery taught me several important lessons. The first is about self-care and creating a plan to enable us to cope with our rigorous and stressful work. Personally, I use counseling, meditation and mindfulness activities, exercise, deep breathing, support groups, and hot showers. I’ve worked hard to develop self-awareness — to know and acknowledge my own emotions and triggers — and I’ve set my own boundaries in both medicine and my personal life. I rearranged the hierarchy of my needs to reflect the fact that I’m a human being, a husband, a father, and then a physician. I learned that I must take care of myself before I can care for anyone else.
The second lesson is about stereotyping… Mental health and substance-abuse conditions have no prejudice, and recovery shouldn’t either. When you live with such a condition, you’re made to feel afraid, ashamed, different, and guilty. Those feelings remove us further from human connection and empathy. I’ve learned to be intolerant of stereotypes, to recognize that every person has a unique story. When we are privileged as professionals to hear another person’s story, we shouldn’t take it for granted.
The third lesson is about stigma….mental health conditions are so stigmatized in the medical profession, given that physicians long fought to categorize them as medical diagnoses. Why do medical institutions tolerate the fact that more than half their personnel have signs or symptoms of burnout? When mental health conditions come too close to us, we tend to look away — or to look with pity, exclusion, or shame….
The fourth lesson is about vulnerability. Seeing other people’s Facebook-perfect lives, we react by hiding away our truest selves. We forget that setbacks can breed creativity, innovation, discovery, and resilience and that vulnerability opens us up to personal growth…And revealing my vulnerability …has unlocked their compassion, understanding, and human connection…benefits of living authentically far outweigh the risks…My openly discussing recovery also revealed the true identity of others. I quickly discovered the supportive people in my life. I can now seek work opportunities only in environments that support my personal and professional growth.
The fifth lesson is about professionalism and patient safety. We work in a profession in which lives are at risk, and patient safety is critically important…Physicians who are successfully engaged in a treatment program are actually the safest, thanks to their own self-care plans and support and accountability programs.
The last lesson is about building a support network…
http://www.nejm.org/doi/full/10.1056/NEJMp1615974
A Quiet Drug Problem Among the Elderly
ReplyDeletePaula Span
MARCH 16, 2018
…For years, geriatricians and researchers have sounded the alarm about the use of benzodiazepines among older adults. Often called “benzos,” the problem drugs include Valium (diazepam), Klonopin (clonazepam), Xanax (alprazolam) and Ativan (lorazepam).
The cautions have had scant effect: Use of the drugs has risen among older people, even though they are particularly vulnerable to the drugs’ ill effects…many patients take them for years, though they’re recommended only for short periods. The chemically related “z-drugs” — Ambien, Sonata and Lunesta — present similar risks.
Now the opioid epidemic has generated fresh warnings, because pain relievers like Vicodin (hydrocodone with Tylenol) and OxyContin (oxycodone) are also frequently prescribed for older people. When patients take both, they’re at risk for overdosing.
“Why are opioids dangerous? They stop you from breathing, and they have more power to do that when you’re also taking a benzo,” said Keith Humphreys, a Stanford University researcher and co-author of a disturbing editorial about overuse and misuse of benzodiazepines last month in the New England Journal of Medicine.
…By 2015, benzo deaths in that age group had jumped to 431, with more than two-thirds involving an opioid. (Benzo-related deaths in all age groups totaled 8,791.) In 2016, the Food and Drug Administration issued a black-box warning about co-prescribing benzodiazepines and opioids, including those in cough products.
Even patients taking the drugs exactly as prescribed can unwittingly wind up in this situation, since both sleep problems and chronic pain occur more frequently at older ages. “A psychiatrist puts a woman on Xanax,” Dr. Humphreys said. “Then she hurts her hip, so her primary care physician prescribes Vicodin.”
But fatal overdoses — which are a comparatively tiny number given the size of the older population — represent just one of many longtime concerns about these medications.
…said Michael Schoenbaum, an epidemiologist at the National Institutes for Health. “Way too many older Americans are getting benzos. And of those, many — more than half — are getting them for prolonged periods. That’s just bad practice. They have serious consequences.”
Probably the most serious: falls and fractures, already a common danger for older people, because benzos can cause dizziness. They’re also associated with auto accidents, given that they cause drowsiness and fatigue.
Moreover, “they have a negative effect on memory and other cognitive function,” says Dr. Donovan Maust, a psychiatrist at the Veterans Administration Ann Arbor Health Care System…
Yet when Dr. Maust and his colleagues looked at a broad national sample of older adults, they found that the proportion of primary care and psychiatry visits that resulted in benzo prescriptions rose from 5.6 percent in 2003 to 2005 to 8.7 percent just seven years later — including 11.5 percent of visits by patients older than 85.
A study by Dr. Schoenbaum as a co-author and published in JAMA Psychiatry reported nearly nine percent of adults aged 65 to 80 taking benzos in 2008.
In both studies, women used the drugs more than men.
Persuading older people that benzos can hurt them — and that alternative treatments like cognitive behavioral therapy and improved sleep hygiene can be as effective for insomnia, though they take longer — has proved an uphill fight.
…“There’s a parallel with alcohol,” he said. “Maybe you had a double Scotch before dinner without problems through your 50s. In your 60s, you get lightheaded” from the same amount, because older bodies metabolize drugs differently…
... “Weaning someone off these things when they’ve become habituated is incredibly difficult,” Dr. Schoenbaum said.
… “You never, ever recommend that someone stop cold turkey,” Dr. Maust said. That can bring withdrawal symptoms that include nausea, chills, anxiety, even delirium. “You taper down very gradually.”
https://www.nytimes.com/2018/03/16/health/elderly-drugs-addiction.html