Do not use benzodiazepines in elderly patients as a first choice for insomnia, agitation, delirium.

Do not use benzodiazepines in elderly patients as a first choice for insomnia, agitation, delirium.

Type of practice

Drugs

Age

Geriatric

Topic Area

Hospital Internal Medicine

Anxiety, depression and insomnia are very frequent in the elderly population and often require pharmacological treatment. Benzodiazepines are still frequently prescribed in the elderly; however, they do have side effects, even severe ones, such as excessive sedation, dizziness, delirium and ideo-motor slowing, with an increased risk of falls and, therefore, fractures. Several studies show that long-term use of benzodiazepines may lead to addiction and increases the risk of dementia. Therefore, it seems appropriate to reduce and possibly avoid the use of benzodiazepines, particularly in the elderly with dementia. In case, their use should be limited to a short period of time (< 1 month), at the lowest possible doses and preferring molecules with a short half-life, gradually discontinuing their consumption.

Sources

1. Fick DM, Cooper JW, Wade WE, et al. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med 2003;163:2716–24. doi: 10.1001/archinte.163.22.2716
2. Ashton H. Guidelines for the rational use of benzodiazepines. When and what to use. Drugs 1994;48:25–40. doi: 10.2165/00003495-199448010-00004.
3. Olfson M, King M, Schoenbaum M. Benzodiazepine use in the United States. JAMA Psychiatry 2015;72:136-42. doi: 10.1001/jamapsychiatry.2014.1763.
4. American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatric Society 2015 updated Beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2015;63:2227-46. doi: 10.1111/jgs.13702.
5. Picton JD, Marino AB, Nealy KL. Benzodiazepine use and cognitive decline in the elderly. Am J Health Syst Pharm 2018;75:e6-e12. doi: 10.2146/ajhp160381.

Download

PDF

Attention. Please note that these items are provided only for information and are not intended as a substitute for consultation with a clinician. Patients with any specific questions about the items on this list or their individual situation should consult their clinician.