Psychotropic medication use in the elderly
pp. 293-306
in: Psychiatry and neuroscience update II, Berlin, Springer, 2017Abstract
Aging is associated with progressive decrease in the function of multiple organs, presence of comorbidities, polypharmacy, and functional and social problems that may lead to inappropriate use of drugs. Consequently, the elderly are very vulnerable to display adverse reactions, interactions, hospitalizations, mortality, and poor adherence to treatment. The most serious side-effects in the elderly are caused by antiplatelet agents, diuretics, anticoagulants, and non-steroidal anti-inflammatory drugs; and within psychotropic drugs, benzodiazepines, antidepressants, and antipsychotic medications are of high risk. Anxiolytics produce excessive sedation, decreased alertness, confusion, ataxia, falls and hip fractures, increased mortality, and impairment of dementia symptoms. Antidepressants may lead to lack of response to treatment and anticholinergic effects. Antipsychotics may produce limited benefit and stroke. A deeply rooted cultural problem in the West is to see old age as synonymous of illness, the elderly being inevitably favorite targets of medicalization, particularly with psychotropic drugs. Problems of everyday life such as sadness or anxiety have become diseases that can be treated with anxiolytics or antidepressants. Psychotropic drugs relieve symptoms that produce certain diseases; if they are used for another purpose, this is considered inappropriate use. Health professionals should contribute by: reducing excessive and unnecessary consumption of psychotropic drugs, promoting their de-prescription, encouraging patients to face their difficulties without drugs, and searching for other solutions such as adoption of hygienic–sanitary measures, reducing risks to patient health, and reducing health costs. For these reasons, our objective is to describe some aspects related to the use of psychotropic drugs in the elderly, suggesting possible measures to improve it.