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Reducing the use of benzodiazepines would greatly reduce the development of dementia. It's about time we were given the job of doing something about it

A while ago I wrote about research from America that had demonstrated an important role for community pharmacists in reducing the prescribing of benzodiazepines for older people. Sadly, it didn't seem to generate much interest.

Despite all the rhetoric about the inappropriate use of these medicines, and the dangers of dependence, nobody seems to care enough to do something that might actually improve matters.

My cynical side tells me that it's because there's no money in it: the drugs are cheap; it would need effort and investment to address the problem; and, anyway, the situation has persisted for years without a major catastrophe, so let's not worry ourselves unnecessarily.

But, recently, more research has come to light, linking the taking of benzodiazepines with an increased risk of dementia. It makes the case for involving pharmacists in reducing the consumption of benzodiazepines so much stronger then before.

The study was published in the British Medical Journal in September this year. It investigated the risk of developing Alzheimer's disease as a result of taking a benzodiazepine. Nearly 2,000 people with a diagnosis of Alzheimer's disease were matched with about 7,000 non-Alzheimer's controls. All patients were over the age of 65. The medicines prescribed for both groups for the previous five years were compared.

Risk

Overall, taking a benzodiazepine increased the risk of getting Alzheimer's disease by over 50 per cent. Long-acting benzos €“ like diazepam and nitrazepam, the ones that are supposed to be less likely to cause dependence €“ increased the risk even more: to 70 per cent. Taking a benzodiazepine for longer than six months increased the risk by over 80 per cent.

These results are dynamite. It ought to be earth-shattering news. If these were figures for cancer they would have been all over the front pages, I'm sure.

Let's put all this into context. Dementia is the number one cause of loss of independence in older people; it's disabling and it's distressing both for the person affected and their family.

As we get older, dementia rates increase: only one in 100 of 65 year-olds are affected, but it's one in three for 90 year-olds, and, because we're all getting older, the number of people with dementia is expected to double every 20 years.

Taking a benzodiazepine for longer than six months increased the risk of developing dementia by over 80 per cent

On top of that, there are no effective treatments for the underlying disease process €“ all they do is delay the progression of symptoms €“ so care for people with dementia is focused on managing their functional, social, and behavioural problems and any other medical conditions they might have €“ and it costs a packet. If services and budgets are stretched today, imagine how it's going to be in 20 years when the number of people with dementia has doubled.

Scares

And I wouldn't place too much hope in new treatments. If they do come along, they are likely to be very expensive. I can remember when donepezil was launched in the 1990s and the scare stories in the medical press that the NHS would be bankrupted because there were so many people with dementia and donepezil was too expensive. What's going to happen when new medicines come along?

So, suppose €“ just suppose €“ that somebody were to come along and tell you that, in a certain group of older patients, there was the potential to decrease the risk of developing dementia by up to 80 per cent €“ what would you say? If this were a decision that you had to make for your business, the answer would be easy. You would take a look at the evidence, do the sums, speak to your accountant to make sure you hadn't got the sums wrong and then just do it, wouldn't you?

The problem is that people like us live in a world where common sense is normal, even expected. But when it comes to commissioning, common sense seems to take a holiday. There is a problem, a solution, and a group of people ready, willing, and able to deliver the solution. How much more straightforward does it have to get?

This question should transcend common sense. The caring professions have an ethical duty to people with dementia, but no less a duty to people at risk of developing dementia. There is compelling evidence that, in people over the age of 65, consumption of benzodiazepines results in a massive increase in risk.

Cheaper

There is also evidence that, in this same group of patients, there is an effective intervention, delivered by community pharmacists, that delivers a reduction in the use of these medicines. Not only that, it would be cheaper to commission this intervention than to provide care for the patients when they develop dementia. It's a win-win-win situation. Our representative organisations really need to take note and develop cogent proposals to take this forward. Otherwise it will be another missed opportunity in a long line of missed opportunities and I will be tempted to throw in the towel.

Pen name of a practising independent community pharmacist. Withering's views are not necessarily those of ICP