臺灣老年人使用抗焦慮及安眠鎮靜藥物之現況及對策

Current Status and Strategies for Use of Anxiolytics and Hypnosedatives among the Elderly in Taiwan

抗焦慮、安眠鎮靜藥物的廣泛使用在臺灣已經成為重要的公衛議題。相較於世界各國，臺灣老年人整體使用抗焦慮、安眠鎮靜藥物有盛行率偏高、處方較久、劑量較高之傾向，而老年人可能容易誤用及依賴此類藥物，而承受認知功能缺損、骨折、交通事故的風險。臺灣老年人失眠、焦慮、憂鬱的盛行率並未較其他國家為高，然而可能因精神疾病汙名化、身體化抱怨的傾向及醫療制度的影響，使得抗焦慮、安眠鎮靜藥物廣為應用，接受抗憂鬱劑治療焦慮、憂鬱的比率則甚低。欲減少新的使用者，進行睡眠衛教、評估主訴下潛藏的焦慮與憂鬱症狀並給予治療，可能有助益。對於已服藥一段時間者，也可進行適當的藥物衛教，並逐步減藥。若條件許可，搭配認知行為治療等心理治療模式應能期待更佳療效。

Wide use of anxiolytics and hypnosedatives has become an important public issue in Taiwan. Compared with other countries, the elderly in Taiwan tended to have a higher prevalence of anxiolytics and hypnosedatives prescriptions and use higher doses for a longer duration. The elderly might misuse or be dependent on these drugs, which leads to risks of cognitive function decline, fracture and traffic accidents. The prevalence of insomnia, anxiety or depression of Taiwanese elderly was not higher than other countries. However, due to stigmatization of mental illnesses, somatization tendency and influence from medical service system, anxiolytics and hypnosedatives were widely used and the proportion of Taiwanese elderly receiving antidepressants to treat anxiety or depression was quite low. To decrease potential users, it might be beneficial to perform sleep hygiene education and to evaluate and treat anxiety and depression under the chief complaints. For those who have used anxiolytics and hypnosedatives for a substantial period, it is still worthwhile to give appropriate education for anxiolytics and hypnosedatives use and try to taper down the dose gradually. Combining psychotherapy, such as cognitive behavior therapy, might lead to a better treatment outcome if the resource is available.