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Clearing the Mind: Benzodiazepines and the Aging Brain
2016 AAGP Annual Meeting to involve using non-traditional means that are acceptable in these at-risk populations. This session will illustrate novel strategies such as the use of paraprofessionals (e.g., community health workers) and technology (e.g., tablet) to deliver simple, scalable interventions. Faculty Disclosures: Stephen J. Bartels Nothing to disclose Sara J. Czaja Nothing to disclose Philip S. Harvey Consultant: Acadia—Phase 3 trials Consultant: Boeheringer_Ingelgeim—Phase 3 trials Consultant: Forum Pharma—Phase 3 trials Consultant: Otsuka America—Phase 3 trials Consultant: Sunovion—Phase 3 trials Consultant: Sanofi—Phase 3 trials Consultant: Takeda—Phase 3 trials Daniel Jimenez Nothing to disclose
CLEARING THE MIND: BENZODIAZEPINES AND THE AGING BRAIN Session 401 Melinda S. Lantz1,2; Pui Y. Wong1,2; Maria Varvara2; Amy Harsany1 1
Mount Sinai Beth Israel, New York, NY Icahn School of Medicine at Mount Sinai, New York, NY
2
Abstract: The dangers of benzodiazepine use have been increasingly well-described. The risks of these agents are significant, including an increase in falls, hip fractures and cognitive impairment. Recent research indicates that use of benzodiazepines and related drugs is associated with an increased risk of dementia. The argument can be made that the risk of these agents outweigh the benefits for the majority of older persons. The history of benzodiazine use crosses decades of remarkable progress and development. These agents were marketed as miraculous cures of all anxiety, promoted to some of the most widely prescribed drugs world-wide and became a model for chemical dependency. Prescriptions of these agents to elderly patients remain robust and older adults continue to receive more benzodizepines than other age groups despite the increased risk of adverse events. This continues despite advances in the treatment of anxiety, mood and sleep disorders that now includes several forms of CBT and alternative pharmacologic agents. Reducing and eliminating the use of these agents, “clearing the mind”, in elderly patients may pose many challenges. We discuss a clinical pathway for the elimination and reduction in benzodiazepine use in elderly patients.This structured pathway uses patient engagement, alternative agents, psychotherapy and education. Both patient and physician factors correlate with successful reductions in benzodiazepine use. Faculty Disclosures: Amy Harsany No Answer Melinda S. Lantz Nothing to disclose
Am J Geriatr Psychiatry 24:3, Supplement 1
S31
2016 AAGP Annual Meeting Maria Varvara No Answer Pui Y. Wong Nothing to disclose
INTEGRATED CARE: LESSONS FROM THE VETERANS ADMINISTRATION PC-MHI PROGRAM Session 402 Paul D. Kirwin1,2; Andrew Pomerantz3; Michelle Conroy1,2; Ilse R. Wiechers1,2 1
Yale University School of Medicine, New Haven, CT VA Connecticut Healthcare System, West Haven, CT 3 Office of Mental Health Services, VHA, Washington, DC 2
Abstract: The Veterans Administration Primary Care-Mental Health Integration Program (PC-MHI) was established to enhance collaboration between Primary Care and Mental Health in attempts to increase access, decrease stigma, and provide immediate, time limited mental health care co-located in a primary care setting. The VA PC-MHI home page overview describes the effort as follows: “Integrated care can be administered either by primary care providers who are given appropriate support, or by collaborating behavioral health providers based in primary care. These types of arrangements can promote patient engagement in and adherence to treatment, avoid stigmatization, and allow providers to coordinate care for mental health problems and other medical conditions.” This approach is especially advantageous in early detection and treatment of neuropsychiatric disorders in late life. Faculty Disclosures: Michelle Conroy Nothing to disclose Paul D. Kirwin Nothing to disclose Andrew Pomerantz No Answer Ilse R. Wiechers Nothing to disclose
SENIOR INVESTIGATOR WORKSHOP Session 403
Helen Lavretsky1; Molly V. Wagster2; George Niederehe3; Jovier Evans3 1
UCLA, Los Angeles, CA NIH/NIA, Bethesda, DC 3 NIH/NIMH, Bethesda, CA 2
Abstract: The Research Committee will organize this workshop in collaboration with program officers from the NIMH and NIA who will serve as presenters (Jovier Evans, George Niederehe, and Molly Wagster are invited). The presenters will review program developments, and transitions within the NIMH and NIA that are critical for investigators to hear about at meeting time, as well as current funding opportunities, including relevant RFAs or other opportunities made available through the NIH Common Fund or Neuroscience Blueprint. Among the topics for discussion will be the evolving landscape at NIH for interventions’ research, especially critical for those investigators involved in intervention development. Funding priorities for
S32
Am J Geriatr Psychiatry 24:3, Supplement 1
CLEARING THE MIND: BENZODIAZEPINES AND THE AGING BRAIN Session 401 Melinda S. Lantz1,2; Pui Y. Wong1,2; Maria Varvara2; Amy Harsany1 1
Mount Sinai Beth Israel, New York, NY Icahn School of Medicine at Mount Sinai, New York, NY
2
Abstract: The dangers of benzodiazepine use have been increasingly well-described. The risks of these agents are significant, including an increase in falls, hip fractures and cognitive impairment. Recent research indicates that use of benzodiazepines and related drugs is associated with an increased risk of dementia. The argument can be made that the risk of these agents outweigh the benefits for the majority of older persons. The history of benzodiazine use crosses decades of remarkable progress and development. These agents were marketed as miraculous cures of all anxiety, promoted to some of the most widely prescribed drugs world-wide and became a model for chemical dependency. Prescriptions of these agents to elderly patients remain robust and older adults continue to receive more benzodizepines than other age groups despite the increased risk of adverse events. This continues despite advances in the treatment of anxiety, mood and sleep disorders that now includes several forms of CBT and alternative pharmacologic agents. Reducing and eliminating the use of these agents, “clearing the mind”, in elderly patients may pose many challenges. We discuss a clinical pathway for the elimination and reduction in benzodiazepine use in elderly patients.This structured pathway uses patient engagement, alternative agents, psychotherapy and education. Both patient and physician factors correlate with successful reductions in benzodiazepine use. Faculty Disclosures: Amy Harsany No Answer Melinda S. Lantz Nothing to disclose
Am J Geriatr Psychiatry 24:3, Supplement 1
S31
2016 AAGP Annual Meeting Maria Varvara No Answer Pui Y. Wong Nothing to disclose
INTEGRATED CARE: LESSONS FROM THE VETERANS ADMINISTRATION PC-MHI PROGRAM Session 402 Paul D. Kirwin1,2; Andrew Pomerantz3; Michelle Conroy1,2; Ilse R. Wiechers1,2 1
Yale University School of Medicine, New Haven, CT VA Connecticut Healthcare System, West Haven, CT 3 Office of Mental Health Services, VHA, Washington, DC 2
Abstract: The Veterans Administration Primary Care-Mental Health Integration Program (PC-MHI) was established to enhance collaboration between Primary Care and Mental Health in attempts to increase access, decrease stigma, and provide immediate, time limited mental health care co-located in a primary care setting. The VA PC-MHI home page overview describes the effort as follows: “Integrated care can be administered either by primary care providers who are given appropriate support, or by collaborating behavioral health providers based in primary care. These types of arrangements can promote patient engagement in and adherence to treatment, avoid stigmatization, and allow providers to coordinate care for mental health problems and other medical conditions.” This approach is especially advantageous in early detection and treatment of neuropsychiatric disorders in late life. Faculty Disclosures: Michelle Conroy Nothing to disclose Paul D. Kirwin Nothing to disclose Andrew Pomerantz No Answer Ilse R. Wiechers Nothing to disclose
SENIOR INVESTIGATOR WORKSHOP Session 403
Helen Lavretsky1; Molly V. Wagster2; George Niederehe3; Jovier Evans3 1
UCLA, Los Angeles, CA NIH/NIA, Bethesda, DC 3 NIH/NIMH, Bethesda, CA 2
Abstract: The Research Committee will organize this workshop in collaboration with program officers from the NIMH and NIA who will serve as presenters (Jovier Evans, George Niederehe, and Molly Wagster are invited). The presenters will review program developments, and transitions within the NIMH and NIA that are critical for investigators to hear about at meeting time, as well as current funding opportunities, including relevant RFAs or other opportunities made available through the NIH Common Fund or Neuroscience Blueprint. Among the topics for discussion will be the evolving landscape at NIH for interventions’ research, especially critical for those investigators involved in intervention development. Funding priorities for
S32
Am J Geriatr Psychiatry 24:3, Supplement 1