Psychiatric Drugs and Medications Q 37
When administering antianxiety medications to an elderly client, which of the following actions by the nurse is essential?
A. Monitor vital signs
B. Suggest reduced doses
C. Taper dose before stopping
D. Implement a fall prevention protocol
Correct Answer: D. Implement a fall prevention protocol
Increased sedation, dizziness, and hypotension are side effects that place the elderly at high risk for falls. The use of benzodiazepines among elderly patients has been associated with intellectual and cognitive impairment. Cognitive impairment is characterized by anterograde amnesia, diminished short-term recall, and increased forgetfulness.
Option A: All clients need to have vital signs monitored periodically when taking these medications. Benzodiazepines and other types of sedative-hypnotics, such as Z-drugs, are no longer recommended for treating insomnia in older adults and are considered inappropriate. In addition to causing memory impairment, falls, fractures, and motor vehicle accidents, data now show that sedative-hypnotics account for a substantial number of avoidable emergency department visits and hospital admissions. Even episodic use is associated with harm. A lifetime use of more than 90 doses of benzodiazepines, equivalent to twice a week for 1 year, has been shown to confer a 50% higher risk of dementia and to double the risk of death.
Option B: Geriatric clients may require reduced doses, but the risk for falls is still present. The risk of hip fracture is greatest within the first 2 weeks of therapy, increasing with higher doses and concomitant administration of other centrally acting nervous system drugs. Patients should be maintained on their current doses until symptoms resolve or be encouraged to push through the taper until they are drug-free. Substitution with diazepam was previously recommended for formulations of benzodiazepines that could not be halved or quartered, but skipping doses every 2–3 days is a simpler strategy to gradually reduce drug levels.
Option C: Dose tapering is not related to age. No magic formula exists for tapering benzodiazepines, as different protocols have not been compared. Some authorities recommend tapering the dose by 25% every 2 weeks; in elderly patients, a longer tapering schedule over 4–5 months is generally preferred. Withdrawal symptoms tend to be most severe during the last quarter of the taper. Updosing (returning to a higher dose) should be avoided.