Systemic model of chronic benzodiazepine use among mature adults.

OBJECTIVES: 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. METHOD: 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. CONCLUSION: We conclude that a predominantly biomedical perspective on human development diminishes patient-centered care within a socially contextualized, individual perspective.

Chronic psychotropic drug use among frail elderly women receiving home care services.

Over the years, psychotropic drugs have been prescribed for symptoms of anxiety and/or insomnia. Elderly women are especially at risk of chronic use and ensuing side-effects. We examined psychosocial processes associated with long-term psychotropic drug use. We conducted in-depth interviews with 21 frail elderly women in a home care program and 14 of their primary caregivers. Results yielded a descriptive model of chronic use that takes into account antecedents of use, initial and subsequent prescription processes, individual contextual circumstances, the effect of the social context, and the women's cognitive strategies employed to make prolonged use coherent with their self-image.

[Social support offered by members of the social network: the point of view of mothers in situation of vulnerability]. / Le soutien parental offert par les membres du réseau social: le point de vue des mères en situation de vulnérabilité.

The present study focuses on informal social networks and the people who give parental support to at-risk mothers (i.e., mothers who display at least two of the following risk factors : low SES, low education, and under 21 years at the birth of their first child). A sample of 49 such mothers, who had children between the ages of 2 and 6 years, participated in semi structured interviews. The group was then matched with a group of low risk mothers (n = 43). Results present mothers' perspectives on the people in their social network they see as being most helpful or most stressful, as far as parenting is concerned. They also describe the roles played by key members of their immediate environment (maternal grandmothers, spouse or ex-spouse). Practical guidelines towards a network-oriented approach in parental support are outlined.