All people, in all corners of the world, are subject to the effects of aging. Various factors favor the success of this inexorable process, and among them are access to health services and self-care, in the physical, socio-familial and psychological spheres.
However, certain habits make it difficult for us to face this stage of existence with health and quality of life. Two of the most determining factors are the consumption of psychotropic drugs such as benzodiazepines and, in general, the abuse of medications.
Benzodiazepines are used to treat insomnia and anxiety – common in people of a certain age – as well as seizure disorders, alcoholism, hypertension and irritable bowel syndrome. For short periods, with appropriate doses and close medical monitoring, they are useful, but they can produce unwanted effects in people over 60 years of age from four weeks after consumption.
Among the medications that older people take the most in Latin American countries are Diazepam, with up to 78% of prescriptions (making it the drug of choice), followed by Clonazepam (68%) and Lorazepam ( 25.6%). They are consumed more by women, between 61 and 92.3%, who mostly self-medicate to treat insomnia and anxiety.
Spain, according to a report from the International Narcotics Control Board, is the world leader in the consumption of benzodiazepines: 110 daily doses per 1,000 inhabitants in 2020. To put it in perspective, Germans ingest an average of 0.04 doses each day.
In older people, even with appropriate guidelines and for periods as short as four weeks, this medication predisposes to generating dependence. That is to say, its “beneficial” effects on the body require taking it for long periods and at higher doses.
The unwanted symptoms associated with its consumption in the short term are headache, dizziness, tachycardia and nausea. In the medium and long term, the following must be added: sedation, dizziness, vertigo and motor incoordination, manifestations that increase the risk of falls and fractures.
There is also functional and cognitive deterioration that, if not detected and corrected, can lead to dementia. In fact, those who take benzodiazepines without close monitoring and for prolonged periods have a 78% greater chance of suffering from it. It is a condition that affects all spheres of the person, considerably reducing their quality of life.
It has also been found that the aforementioned symptoms increase when combined with more than three to five medications simultaneously (polypharmacy). Below we will address this problem.
Polypharmacy frequently occurs in the geriatric population: the older you are, the more diseases and the greater the need for medications to treat them, which are not always appropriate. Throughout the world it occurs in between 5% and 78% of the population, depending on the country we are talking about. For example, in the United States it affects 57% of its inhabitants, in Mexico, 65% and in Europe, 51%, being associated with higher mortality.
The problem of polypharmacy is mainly due to three factors:
The main unwanted effects of these pharmacological “cocktails” are memory, sleep and mood disorders, which can even lead to delirium and/or depressive symptoms. They can also cause palpitations, dizziness, vertigo and tremors – which predispose to loss of mobility and increase the risk of falls –, greater adverse effects, risk of fragility and an increase in consultations, especially visits to emergency services.
The recommendation is to go to gerontology professionals to coordinate the specialized teams that will care for the patient. In addition, the geriatrician will carry out a comprehensive assessment to identify problems that go unnoticed in the usual medical history.
With this tool it is possible to make individualized diagnoses and treatments, avoiding drug abuse and an increase in hospitalizations. In addition to improving the patient's functional status and reducing their risk of mortality, the professional will be able to inform them about self-care guidelines. A great way to show love through holistic health.
This article was originally published on The Conversation.
Katya Aurora Rábago Olivares is a master in Gerontology, Professor of the degree in Gerontology, University of Guadalajara.
