Morgan K
Department of Health Care of the Elderly, University of Nottingham Medical School, England.
Drugs. 1990 Nov;40(5):688-96. doi: 10.2165/00003495-199040050-00004.
At any age hypnotic drug use can give rise to 3 major problems: unwanted effects on daytime mood and behaviour associated with drug consumption; rebound effects associated with drug withdrawal; and dependency associated with long term drug use. For 2 reasons elderly hypnotic users are both more vulnerable and more exposed to each of these problems. Firstly, age-related changes in pharmacodynamic and pharmacokinetic processes amplify the behavioural impact of many hypnotics; and secondly, age-related changes in the structure and quality of sleep tend to increase the demand for, and the long term use of, sedative hypnotic compounds in old age. The existence of physical illness, cognitive impairment, or daytime behaviour already compromised by normal aging processes further increases the likelihood of hypnotic drugs detrimentally affecting well-being in later life. These important causes for concern emphasise the need for 2 separate clinical responses: the need for greater circumspection in the choice and use of hypnotic drugs among elderly patients, and the need for a more broadly based clinical approach to the management of sleep problems in old age.
在任何年龄，使用催眠药物都会引发3个主要问题：与药物服用相关的对日间情绪和行为的不良影响；与药物戒断相关的反跳效应；以及与长期药物使用相关的依赖性。出于两个原因，老年催眠药物使用者更容易受到这些问题的影响，且接触这些问题的机会更多。首先，药效学和药代动力学过程中与年龄相关的变化会放大许多催眠药物的行为影响；其次，睡眠结构和质量与年龄相关的变化往往会增加老年人对镇静催眠化合物的需求以及长期使用。身体疾病、认知障碍或正常衰老过程已经损害的日间行为的存在，进一步增加了催眠药物对晚年幸福感产生不利影响的可能性。这些令人担忧的重要原因强调了两种不同临床应对措施的必要性：在老年患者中选择和使用催眠药物时需要更加谨慎，以及需要采用更广泛的临床方法来管理老年人的睡眠问题。
