L’expérience subjective des personnes âgées lors d’une intervention de sevrage des benzodiazépines et l’impact du sevrage sur les processus d’identité

The use of benzodiazepines to manage anxiety and insomnia remains a concern in the elderly, although the harmful effects of these drugs are more widely publicized to this population and a variety of interventions are offered to help them cease their use. The seniors' self-perceptions of their competences to cope with difficulties, with or without use of medication, while maintaining a positive self-image, seem to influence their BZD intake and the discontinuation outcome. This qualitative study explores the impact of these self-perceptions on the trajectories developed by the participants during a discontinuation intervention. Thus, twelve participants having undergone three different types of intervention were interviewed for this study, within three to four years after the discontinuation intervention to record and analyze their experiences throughout the interventions. Using grounded theory as an analytical approach, an attitude of agency, an attitude of resignation, and an attitude of ambivalence were identified in response to withdrawal based on the variability in a number of common characteristics. These characteristics include the general health status, the quality of the relationship with health professionals, the quality of introspection regarding the harmful effects of BZDs and the psychological processes involved in the onset and maintenance of insomnia and/or anxiety, the type of motivation, the belief in one's competence to discontinue the medication, the attitudes toward BZD use, the duration of their use, the severity of withdrawal symptoms, the expectations regarding the research support, and the attitudes toward ageism and medication prescription among the elderly. The variability of these characteristics leads the participants to develop action strategies by engaging or disengaging in the withdrawal intervention, which results either in a complete or nearly complete discontinuation (corresponding to agency), or in a decrease or maintenance of the BZD intake (corresponding to resignation and ambivalence). The outcome is a reinforcement or readjustment of self-perceptions related to health management skills so that the elderly maintain a coherent and positive self-image regardless of their withdrawal result. In conclusion, the results of this study indicate that health professionals could use screening tools based on the identified characteristics to predict the attitude that a BZD user is likely to develop during discontinuation as these characteristics appear to be predictive of the action strategies that are likely to be employed and, subsequently, of the outcomes of withdrawal interventions. Thus, by predicting the attitude that an elderly person could develop during withdrawal and by directing one to the most appropriate intervention according to one’s needs (e.g., self-discontinuation at home using a withdrawal grid, motivational interviewing, regular follow-ups with health professionals, therapy group), the chances of stopping the medication and maintaining the long-term outcome are likely to be maximized.

Keyphrases: Attitude, Ambivalence, Benzodiazepines, Elderly, Discontinuation, Self-perceptions, Perceived competence, Action strategy, Attitude, Agency, Resignation, Ambivalence