6.9. Items connected with sedative drug use (IV)

The home-dwelling elderly use drugs, particularly sedative drugs, commonly. The most frail persons aged 80 years or over, women, those with many diseases, smokers, those with poor self-perceived health/poor life satisfaction, and those having home nursing are most likely to have polysedation.

Part of the sensitivity to drug-induced sedation, motion disturbances and falls, are associated with aging processes (Koponen 2001). Sedation is sometimes a subjective experience and its influence varies from person to person. Hence, reliable objective measurements of sedation are difficult to develop, and they would require laboratory conditions. In this study, no objective measurements were used. Reaction times, sensorimotor functions, and balance control have been measured as indicators of sedation (Lord et al. 1995, Ridout & Hindmarch 2001).

The home-dwelling elderly used sedative drugs commonly. Up to 40% of drug users took proper sedatives. The elderly with polysedation also used a lot of other medicines with sedative properties, i.e. analgesics (Hoppmann et al. 1991), antihistamines (Slater et al. 1999), and drugs with possible sedative properties, such as cardiovascular drugs (Pharmaceutical Information Centre 2000). Insidious extra sedation may be caused by drugs in the large and variable group 3, to which the above-mentioned drugs mainly belong. We do not know the whole sedative load of individual elderly persons, but it is anticipated to be much higher than that reported in this study. A potential sedative combination of drugs may result from complicated medication regimens involving medications, some or all of which have modest sedative effects.

Polysedation was associated with impaired physical functioning. In other words, a large number of sedative drugs cause physical functional disabilities in the elderly. Sedation is sometimes intentional, as in the treatment of acute psychiatric diseases or insomnia (Thompson et al. 1983, Batty et al. 2000). While sedation may initially be benefical, it impairs the person’s functioning (Casey 1997). Impaired physical functioning and poor self-rated health have been found to correlate with the use of sedatives by the home-dwelling elderly (Ried et al. 1998, Blazer et al. 2000), not to mention the risk of falls (Aisen et al. 1992, Ryynänen et al. 1993, Ryynänen et al. 1994, Tinetti et al. 1994, Thapa et al. 1995, Ebly et al. 1997, Cumming 1998, Leipzig et al. 1999a), which risk is increased by a single sedative (zolpidem) alone (Wang et al. 2001). The risks of falls and other accidents should be explored in the future by taking into account the total sedative load of drugs. This study also identified drugs prescribed for the treatment of somatic disorders, which are not traditionally considered sedatives.

In this study, the persons with polysedation used more commonly home nursing services than the other elderly. Home nursing is a challenge for health care professionals because extremely frail elderly persons often live alone. They commonly have physical and mental disorders, polypharmacy, and psychotropic medication (Lithovius et al. 1998), and they are thus at a high risk of institutionalization. On the other hand, polypharmacy in itself is associated with poor physical abilities (Rozzini et al. 1993) and hypotension (Cohen et al. 1998), which also expose the person to balance disorders and mobility problems.

We may be able to improve these persons’ health by withdrawing the injurious extra sedative load of drugs. The use of many sedatives is a risk for functional independence and may cause physical disabilities. The load of sedative drugs may thus increase the need for health and social care and the consequent costs.