Systemic model of chronic benzodiazepine use among mature adults.
OBJECTIVE
Our goal was to build a systemic model of chronic use among community-dwelling mature benzodiazepine (BZD) users. BZDs are commonly prescribed for symptoms of anxiety and/or insomnia despite their documented side effects over time.


METHODS
We conducted in-depth interviews with 23 mature (50 years and over) users, 14 women and 9 men, as well as 9 general practitioners and 11 pharmacists. We chose the grounded theory approach for our analysis.


RESULTS
Results yielded a systemic model of chronic BZD use, illustrating onset and maintenance of use, and taking into account individual life context, intervening conditions (e.g. family and doctor--patient interactions) and structural factors (medicalization, ageism, influence of the media and pharmaceutical industry, etc.). Based on our findings, we suggest that intervention should go beyond medical issues and extend to the individual's perception of aging in the modern society, as well as attitudes of families and health professionals regarding long-term BZD use. Family members should be involved in the weaning process and adoption of new life habits. General practitioners should be better trained regarding geriatric psychosocial issues and offer alternatives to prescribe psychotropic drugs such as cognitive behavior therapy for insomnia. Also, as a society, we should reconsider the highly medicalized stance we take to compensate for age-related losses. The influential role of the pharmaceutical industry in the process is discussed.


CONCLUSIONS
We conclude that a predominantly biomedical perspective on human development diminishes patient-centered care within a socially contextualized, individual perspective.
a Psychology Department , University of Quebec in Outaouais , Gatineau , Canada.
Guilhème
G
Pérodeau
b Calas of Outaouais , Gatineau , Canada.
Émilie
É
Grenon
c Department of Psychology, Geriatric Institute of Montreal , University of Montreal , Montreal , Canada.
Sébastien
S
Grenier
d Psychiatry Department, OCD Spectrum Study Center , University Institute of Mental Health at Montreal, University of Montreal, Montreal , Canada.
Kieron
K
O'Connor
D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000188:drug therapy* / Q000523:psychology; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D001569:Benzodiazepines / Q000627:therapeutic use*; D005260:Female; D058005:General Practitioners; D066296:Grounded Theory; D006801:Humans; D057187:Independent Living; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D018802:Patient-Centered Care; D010595:Pharmacists; D036301:Qualitative Research; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy* / Q000523:psychology
D001569:Benzodiazepines
health professionals; medicalization of aging; model of benzodiazepine use; pharmaceutical industry