Australian and New Zealand Society for Geriatric Medicine
Recommendations from the Australian and New Zealand Society for Geriatric Medicine on benzodiazepines, drug regimen reviews, physical restraints, dementia & bacteruria. ANZSGM is the professional society for geriatricians and other medical practitioners with an interest in medical care of older people. The society acts to represent the needs of its members and the wider community in a bid to constantly review and improve the care of the older people in Australia and New Zealand. Its major functions are around education, policy development and review, and political advocacy.
Do not prescribe benzodiazepines or other sedative-hypnotics to older adults as first choice for insomnia, agitation or delirium.
There is strong evidence that use of benzodiazepines is associated with various adverse effects in elderly people such as falls and fractures. Older patients, their caregivers and their providers should recognize these potential harms when considering treatment strategies for insomnia, agitation or delirium. Thus these drugs should be prescribed with caution, and their use monitored closely.
- Allain H, Bentue-Ferrer D, Polard E, at al. Postural instability and consequent falls and hip fractures associated with use of hypnotics in the elderly: a comparative review. Drugs Aging 2005;22(9):749–765.
- Finkle WD, Der J, et al. Risk of fractures requiring hospitalization after an initial prescription for zolpidem, alprazolam, lorazepam, or diazepam in older adults. Journal of the American Geriatric Soc 2011;59(10):1883-90.
- Park SM, Ryu J, Lee DR, et al. Zolpidem use and risk of fractures: a systematic review and meta-analysis. Osteoporosis Int 2016; Apr 22.
- Sithamparanathan K, Sadera A, Leung L. Adverse effects of benzodiazepine use in elderly people: A meta-analysis. Asian J Gerontol Geriatr 2012;7:107–11.
- Stockl KM, Le L, Shang S, Harada ASM. Clinical and economic outcomes associated with potentially inappropriate prescribing in the elderly. American Journal Manag Care 2010;16(1):e1-10.
Members of the Australian & New Zealand Society for Geriatric Medicine completed an online survey asking them to choose the 5 most relevant ‘low value’ practices from a list of 11. Respondents were also asked to nominate any additional practices which they regarded as overused, inappropriate or of limited effectiveness in the specialty of geriatric medicine. A total of 196 responses were received.
The list of items were then subject to consideration by the Federal Council. Specifically, members of Federal Council were asked to rate each of these 16 items in terms of their strength in meeting 7 criteria: Is there a reasonable evidence base upon which to drive change? Are older people likely to benefit from work we might do to change practice? Is the problem sizeable? Are there opportunities and a willingness within geriatric medicine to lead practice change? Are there opportunities to collaborate with other organisations with a shared interest in the area? Will this promote a positive profile for ANZSGM? Is this an area of potential conflict with other Societies?
Based on the ratings they assigned to these items the ‘Top 5’ list items were chosen and reformulated as recommendations for clinicians.
- 1 Do not use antipsychotics as the first choice to treat behavioural and psychological symptoms of dementia.
- 2 Do not prescribe benzodiazepines or other sedative-hypnotics to older adults as first choice for insomnia, agitation or delirium.
- 3 Do not use antimicrobials to treat bacteriuria in older adults where specific urinary tract symptoms are not present.
- 4 Do not prescribe medication without conducting a drug regimen review.
- 5 Do not use physical restraints to manage behavioural symptoms of hospitalized older adults with delirium except as a last resort.