Systematic review: Indiscriminate use of benzodiazepines against anxiety and depression in older adults, 2020-2023

Introduction

At present, anxiety and depression have become more and more frequent psychological disorders in the population, mainly in older adults, since they are in a stage of their lives where they can perceive family abandonment, as well as the manifestation of diseases., the change in the rhythm of life, reduction of responsibilities and problems sleeping. For this reason, they resort to benzodiazepines as treatment, but in the long term they produce dependency, increased anxiety, and aggressive behaviors that affect the nervous system.¹ This systematic review seeks to know the characteristics such as sex and age of geriatric patients with anxiety and depression.² Therefore, we ask ourselves, what are the characteristics of older adults who suffer from anxiety and depression, treated with benzodiazepines? Also, what is the predominant gender in the consumption of benzodiazepines in older adults? And what are the ages of older adults who consume benzodiazepines?

Conceptualizing the scientific part of the search for knowledge to give it background support, we will mention that the use of Benzodiazepines could end up being harmful to the health of consumers, even more so in a population at risk such as the elderly. Triggering adverse reactions such as ataxia, excessive sedation, among others. In addition, we highlight in the studied population, that the female sex was the predominant one in the intake of benzodiazepines. On the other hand, we identified that the age range goes from 60 to 69 years. Likewise, the risk of suffering from mental disorders due to age increases in the population over 65 years of age.^3–6

Regarding the epistemology of the variables, it is said that the indiscriminate use of benzodiazepines, according to Feliz FJ. et al. (2021) can cause health consequences for those who consume it, triggering dependence on the drug and complexity to complete the treatment of mental disorders.⁷ Likewise, it indicates that the age population is the one that uses benzodiazepines the most, as a result of their susceptibility to suffering from certain disorders.⁸ In addition, according to Villagrasa B. (2020) defines that mental disorders such as depression and anxiety in the long run could increase the risk of suffering from vascular dementia and Alzheimer’s.⁹ In accordance with this, it is urged to be more interested in the mental health of the elderly and, since there is no definitive cure, to try to prevent it to avoid future consequences.

The purpose of this systematic review is to publicize the indiscriminate use of benzodiazepines as a treatment for anxiety and depression in older adults, it also seeks to identify which gender consumes more of these drugs and to know their ages.

The general objective of this systematic review is to know the main characteristics of older adults who use benzodiazepines as a treatment for anxiety and depression during the years 2020-2023. Therefore, we establish as the first specific objective, to identify the predominant gender in older adults who consume benzodiazepines as a treatment for anxiety and depression during the years 2020-2023. Likewise, the last specific objective seeks to know the ages of older adults who consume benzodiazepines as a treatment for anxiety and depression during the years 2020-2023.

Methods

This paper is a systematic review based on the methodology established in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Said scientific information included in the study was compiled from different international databases such as Dialnet, Google Academic, Elsevier, Formación Médica Continuada, Editorial Reves, Mental Health Nursing, National Institutes of Health, Paraninfo Digital, Repositorio Continental, Repositorio UAC, Repositorio UMA, Scielo and Scopus from January 2020 to February 2023; Boolean operators (AND and OR) were used, accompanied by variables (Benzodiazepine, Anxiety, Depression, Older Adult) in the searches of the Continental Repository, where we obtained more study material; then we complemented with research from Google Scholar, which provided us with research from Scielo, Dialnet, WHO, Digemid and more. Subsequently, of the studies chosen (192), we eliminated 26 through the Excel program due to duplication; 14 records not eligible for the Smartsheet program and 11 articles that were not related to the study population. Within the information extraction process, a detailed reading of the chosen articles was made, collecting only information that responds to our statement of the problem and/or is related to the topic. Finally, the extraction process helped to filter the necessary information. During the meta-analysis, a search was carried out with the variables “Anxiety”, “Depression” and “Benzodiazepines”, using the Boolean operators “AND” and “OR”, where little information related to the indiscriminate use was found, but in the searches Related to “Older Adult” we found a large amount of study material associated with mental disorders that we could relate to benzodiazepines.

Results

In Figure 1, the initial sample was 192, through 10 registered databases and which contained 34 investigations (28 originals and 6 systematic reviews). The articles that were rejected for not meeting the inclusion criteria were 51, mainly because they were duplicate records that were later eliminated through the quality assessment instruments.

Figure 1. Flowchart of identification, screening, eligibility and included items.

Table 1 shows the distribution of the search results by the title of each article, the authors, the year, the source and their respective links of the studies finally included. 85% (original research); 15% (systematic reviews). All investigations were included based on the inclusion and exclusion criteria provided in the study methodology.

Both depression and anxiety in older adults are disorders that can be caused by suffering from multiple chronic diseases or, to a lesser extent, by family abandonment.¹⁰ Likewise, in Peru, the majority sector that suffers from depression are women, who mostly presented a physical disability.¹¹ On the other hand, it was identified that the largest population that self-medicated with benzodiazepines estimated an average age between 50 and 60 years (Table 1).¹²

Discussion

Our results agree with a study that measures the level of self-medication (Table 2) of anxiolytics in the elderly, where they reported that benzodiazepines in older adults could trigger disorders such as depression, anxiety, insomnia, fatigue, etc.¹³ To these is added, with another study that defines that anxiety in the elderly has been associated with a reduction in physical activity and in the functional level, less life satisfaction, deterioration in the quality of life. Due to these consequences suffered by older adults, epidemiological studies are relevant given the magnitude of the problem.¹⁴ On the other hand, the NIH (National Institutes of Health) found that women, approximately 65 to 80 years old, are twice as likely as men to take benzodiazepines; reinforcing our findings that demonstrate that benzodiazepines are consumed by elderly women, but with a different age range than ours.¹⁵ As a consequence of self-medication with Benzodiazepines, Bacigalupe maintains that it can lead to mental disorders such as memory loss, disorientation and dependency; This discovery would explain the reason for the indiscriminate use of Benzodiazepines, due to dependence.¹⁶ Likewise, the Spanish magazine Paraninfo, agrees with what was presented in our results, regarding the fact that the female sex is more prone to the consumption of these psychoactive drugs, but affirms that this problem has been rooted since the 50s by pharmaceutical companies to allow them to face the Daily necessities.¹⁷ While in Huancayo it was concluded that mental deterioration in the elderly is caused by different factors associated with lifestyle, this is understood as the most vulnerable population and prone to the use of benzodiazepines to counteract the mental degeneration of the elderly.¹⁸ On the contrary, the Clínica Las Condes Medical Journal differs with respect to the consequences of the use of benzodiazepines, because it maintains that they provide a better lifestyle to the consumer, in addition to improving the quality of sleep.¹⁹ Another aspect to highlight is gender as the predominant mental health and its medicalization. Our findings agree with what is collected in the SESPAS 2020 report, diagnoses of depression and anxiety are also frequent among women of all ages and from all social groups. Even their higher consumption of prescribed psychoactive drugs is significantly higher in the female gender.²⁰ However, we disagree with the results of a study in Arequipa, during 2021, where it indicates that the population that consumes the greatest amount of anxiolytics are not women, but men.²¹ Finally, in opposition to the results of an article indicating that statistically the age range in older adults who consume benzodiazepines is from 65 years onwards, no significant relationship was found with our systematic review since we considered from 50 to 60 years to the elderly consumers of said psychoactive drugs.²²

Conclusion

It was determined that both anxiety and depression are mental disorders caused by different physical, economic, social, environmental factors, etc. The same ones that are more frequent in the age population; since, being more susceptible to suffering from a chronic illness, feeling of invalidity or other depressive thoughts, they lead to their resorting to benzodiazepines as a self-medicated treatment, to cure anxiety and depression. Due to the nature of these drugs, it could make users drug dependent. Which translates as indiscriminate self-medication of benzodiazepines. Therein lies the interest in studying this problem, determining that, in response to our objectives, among the main characteristics of BZD consumers is advanced age, which ranges from approximately 50 to 60 years and that the population most prone to to the consumption of these drugs is female, according to the search for exhaustive information that was carried out in the systematic review. Likewise, the consequences of the misuse of these drugs were identified, ranging from irreversible cognitive deterioration in the elderly, to dependence and degeneration in the quality of life and sleep of the population consuming benzodiazepines. Finally, we urge the population, in general, to identify depressive disorders and anxiety disorders in time in the elderly present in the family, so that they can carry out adequate treatment and be prescribed by a qualified health professional; avoiding self-medication and misuse of benzodiazepines.