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00:00:00 – 00:23:51
The video primarily delves into the types of medications that older adults should avoid to maintain cognitive health, with a substantial focus on benzodiazepines ("benzos") and their risks. Dr. Leslie Kernisan, a geriatrician, highlights the Beers Criteria—a guideline listing harmful medications for the elderly, particularly emphasizing benzos like lorazepam, diazepam, and alprazolam used for anxiety and insomnia. Benzos present substantial risks such as cognitive impairment, increased fall risk, physical dependency, and potential addiction, particularly in those with a history of substance abuse. Tapering off benzos should be done gradually under medical supervision due to severe withdrawal risks.
Alternative treatments for anxiety and insomnia are discussed, including SSRIs like escitalopram and sertraline, and non-drug therapies like cognitive behavioral therapy. The speaker also warns against anticholinergics, which impede neurotransmitter acetylcholine and are found in many common medications, leading to worsened brain function. The use of antipsychotics and mood stabilizers in dementia patients is scrutinized due to their severe side effects, including cognitive slowing and an increased risk of mortality.
The video advises using such medications only as a last resort and advocates exploring non-drug methods to manage behavioral issues. Finally, it stresses the importance of consulting healthcare providers to minimize harmful medications, leveraging the Beers Criteria as a discussion point, and advocating for safer, non-drug alternatives.
00:00:00
In this part of the video, Dr. Leslie Kernisan, a board-certified geriatrician, discusses an important issue she addresses in her practice: the types of brain-slowing medications that older adults should avoid to maintain better memory and brain health. She highlights the significance of the Beers Criteria list, which contains medications detrimental to older adults, particularly those affecting thinking and balance and thus increasing the risk of falls. This issue is even more crucial for individuals diagnosed with mild cognitive impairment, Alzheimer’s, or other forms of dementia. Dr. Kernisan focuses on the first type of these medications: benzodiazepines or “benzos,” which include drugs like lorazepam, diazepam, and alprazolam. Benzos are often prescribed for anxiety, sleep, and in some cases, to manage agitation in Alzheimer’s patients, despite not being FDA-approved for that use. She stresses the importance of recognizing the risks associated with benzos.
00:03:00
In this part of the video, the speaker discusses the efficacy and risks associated with benzodiazepines (benzos) for treating anxiety and insomnia. Benzos are effective in the short term and provide quick relief, but they act on the same brain receptors as alcohol and come with significant side effects, especially as people age. These include slowed brain function, impaired memory, and increased risk of falls. Benzos are also habit-forming, leading to physical dependency and potential addiction, particularly in individuals who have a history of substance abuse. There is a concern about their association with developing dementia, though research is ongoing. The speaker also emphasizes the dangers of stopping benzos abruptly (cold turkey), which can be life-threatening, paralleling the risks seen with sudden cessation of heavy alcohol use.
00:06:00
In this part of the video, the speaker discusses tapering off benzodiazepines, emphasizing that it should be done slowly and under medical supervision. They highlight that tapering can be effective, as shown in clinical trials, notably those developed for older adults. A specific handout, clinically tested and distributed in pharmacies, is mentioned as a tool to help educate patients about the risks of benzodiazepines, alternative anxiety or insomnia treatments, and a tapering schedule. However, tapering is noted to be particularly challenging for individuals with memory loss or conditions like Alzheimer’s or dementia, due to their low tolerance for discomfort.
The speaker also underscores the importance of not waiting until significant memory problems develop before attempting to taper benzodiazepines. Alternatives to benzodiazepines for managing anxiety are suggested, particularly selective serotonin reuptake inhibitors (SSRIs) like escitalopram (Lexapro) and sertraline (Zoloft), which do not slow the brain as much and are effective for anxiety.
00:09:00
In this part of the video, the speaker discusses various medications and non-drug therapies for anxiety and insomnia, highlighting their pros and cons. Prozac, once a popular SSRI, is now less favored due to its interactions with other medications. Non-drug therapies such as cognitive behavioral therapy are emphasized as effective alternatives for managing anxiety. For insomnia, the importance of evaluating underlying causes, such as sleep apnea, is stressed. The speaker notes that while medication is sometimes used for insomnia in geriatrics, non-benzodiazepine prescription sedatives, particularly “Z drugs” like Zolpidem (Ambien), are generally avoided due to their negative impact on cognitive function and balance in older adults. The segment also touches upon the unclear connection between these medications and long-term risks like Alzheimer’s disease, stressing the importance of a cautious approach to their use.
00:12:00
In this segment of the video, the speaker discusses the importance of avoiding medications that slow down the brain, especially for older adults or those with memory issues. They focus on anticholinergics, a large group of medications that block acetylcholine, a crucial neurotransmitter for brain and neuron communication. Common examples include over-the-counter sleep aids, antihistamines like Benadryl, medications for overactive bladder, vertigo, motion sickness, nausea, itching, muscle relaxants, and certain antidepressants like Paxil. The speaker emphasizes that these medications can worsen brain function and suggests watching another video and reading an article for more information. Typical anticholinergic side effects include dry eyes, dry mouth, constipation, and drowsiness.
00:15:00
In this segment, the presenter discusses anti-psychotics and mood stabilizers, which are typically used to treat serious mental illnesses like schizophrenia and bipolar disorder. These medications are sometimes prescribed to older adults with dementia to manage difficult behaviors such as agitation, paranoia, and hallucinations. However, anti-psychotics, especially when used in dementia patients, come with significant risks, including an increased chance of mortality (2-4% within six to 12 months), cognitive slowing, and a higher likelihood of falls. Commonly prescribed medications mentioned include Risperidone, Quetiapine, Olanzapine, Aripiprazole, and Haloperidol for antipsychotics, and Valproate for mood stabilization. The presenter emphasizes that these medications act as chemical restraints and are not FDA-approved for managing dementia-related behaviors.
00:18:00
In this part of the video, the speaker discusses the use of mood stabilizers for managing difficult Alzheimer’s behaviors and agitation. They emphasize that such medications should be used only as a last resort after exploring other methods to manage behavior, such as addressing unmet needs like boredom, fear, pain, or lack of stimulation. The conversation mentions that medications, including benzodiazepines, non-benzodiazepine sedatives, anticholinergics, antipsychotics, and mood stabilizers, should be avoided or minimized, particularly for those with memory concerns. The speaker advises against panicking if one is already on these medications and stresses the importance of consulting healthcare providers to explore safer alternatives. They also note potential challenges in discussing this with doctors, such as busy schedules, lack of geriatrics training, and the effort required to revisit prescribed medications.
00:21:00
In this part of the video, the speaker discusses strategies for reducing medication dependency, especially for older adults. The main points include the challenges doctors face in prescribing non-drug treatments due to time constraints, and the importance of advocating for fewer medications for safety and cost reasons. The speaker suggests specific phrases to use when discussing medication reduction with a doctor, such as mentioning the Beers criteria, which lists medications that older adults should avoid. They also recommend asking about non-drug alternatives and ensuring that any necessary drugs are not on the Beers list or are used at the lowest possible doses. The segment concludes with advice on monitoring the effectiveness of medications and avoiding unnecessary risks if the medication isn’t significantly helping.