The politics of psychoactive drug use in old age

Nurses' Diagnostic Stereotyping of the Elderly

This study experimentally tested three behaviors thought to underlie the clinical decision-making process that permits the systematic labeling of the elderly as senile; namely, when compared to a younger person with identical neuropsychiatric symptoms, an older person will more likely be given a diagnosis of organic brain syndrome, will more likely be given a poor prognosis for recovery, and will more likely be given palliative rather than interventive treatment. The study also examined the impact of contact with older patients on the making of these clinical decisions. Subjects were the entire nursing staff (N = 186) of a general hospital in a northeastern American city. One-half of the sample responded to a vignette of a young person and one-half to a vignette of an old person with identical signs of emotional, behavioral, and perceptual disorder. The results support the notion that clinical decisions tend to be biased against old age and thus contribute to inappropriate labeling of the elderly. Results also suggest that when compared to subjects having little contact with old patients, those having considerable contact were more likely to believe that all patients, regardless of age, have an organic, incurable, and untreatable illness.

Structural Antecedents of Psychoactive Drug Use Among the Elderly

Current literature on the over use of psychoactive drugs by elderly people suggests that alienation, poverty, rolelessness and lack of drug experience in earlier life are principal causes. But these are mainly empirical observations which have not been ordered into any theoretical framework. In proposing the applicability of the concept of ‘internal colonialism’ as a mode of explanation, the paper presents a survey of drug use prevalence as a basis for later conceptual analysis. It is concluded that drug misuse is an institutionalized response which perpetuates dependency.

Usage des benzodiazépines chez les personnes âgées : état des connaissances

Cet article passe en revue la littérature concernant la dépendance aux benzodiazépines (BZD) chez la population des personnes âgées de 65 ans et plus. Alors que les conséquences négatives reliées à l’utilisation prolongée des BZD sont bien connues, le phénomène de la dépendance à ces substances chez cette population l’est beaucoup moins. Il n’existe toujours pas de consensus autour de la définition du problème. L’usage continu des BZD peut être davantage problématique chez les personnes âgées pour qui la tolérance aux agents chimiques diminue avec l’âge. Les facteurs de risque impliqués dans l’usage chronique sont une combinaison interactive entre les caractéristiques des aînés et celles des médecins prescripteurs. Des pistes de recherche étayées sur un changement paradigmatique sont lancées afin de bonifier la recherche dans ce domaine.

Substance use disorders in a geriatric psychiatry outpatient clinic: prevalence and epidemiologic characteristics

This study was conducted to determine the prevalence of substance use disorders in a geriatric psychiatry outpatient clinic. The overall prevalence for any substance use disorder was 20% (N = 28). The prevalence of benzodiazepine dependence was 11.4% (N = 16); the prevalence of alcohol dependence was 8.6% (N = 12); and the prevalence of prescription narcotic dependence was 1.4% (N = 2). These findings suggest that substance use disorders in the geriatric psychiatry outpatient population exist to a significantly greater extent than previously reported. Descriptive statistics were used to characterize patients with benzodiazepine dependence, alcohol dependence, and no substance use disorder. These groups were compared on demographic and clinical variables using one-way analysis of variance (ANOVA) and chi-squared statistical techniques. Clinicians working in comparable outpatient settings may be in a better position to prevent, detect, and treat substance use disorders in their patients as a result of increased awareness of its epidemiologic characteristics in this population.

Can overuse of psychotropic drugs by the elderly be prevented?

Despite increasing awareness of the problems associated with long term psychotropic use, consumption by the elderly remains high. This study examines some of the reasons for this with a view to prevention. Fifty seven elderly patients using psychotropic medication were interviewed to determine the prevalence of psychiatric illness, patterns of drug use, the reasons for the initial prescription and any relationship to life events. Attitudes to continued use were also assessed. The results suggest that levels of psychotropic use by the elderly could be reduced by improved management of life crises and insomnia.

Changing models of community mental health services

The various comprehensive community mental health centers developed at the same time as the free clinics intended to provide an alternative form of service. The origins and contributions of each of these directions of service are compared on such matters as funding, political orientation, relation to local government, the composition and functions of their boards, and their models of service delivery. The case is made that the two forms have shown a degree of convergence that shapes the present reality of what is or is not a legitimate part of mental health services.