Introduction. In older people, use of long-acting benzodiazepines are associated with multiple risks, including falls, drowsiness and ataxia, cognitive decline, impaired psychomotor function, and risk of dependence (Voyer et al., Reference Voyer, Preville, Cohen, Berbiche and Beland2010).
Several studies showed evidence for increased risk of hip fracture and recurrent falls among elderly patients taking benzodiazepines. The risk of falls has been associated with sudden increases in dosage and with continuous use of benzodiazepines (14).
Long half-life benzodiazepines usually are not preferred for older patients because of cumulative toxicity. Among the short half-life drugs, high-potency compounds (e.g., lorazepam, alprazolam) may be more toxic than low-potency compounds (e.g., oxazepam).
While benzodiazepines are highly effective in the short term, adverse effects associated with long-term use, including impaired cognitive abilities, memory problems, mood swings, and overdoses when combined with other drugs, may make the risk-benefit ratio unfavourable.
On the basis of their shorter half-lives and lack of (or rapid disappearance of) active metabolites produced by their mode of metabolism, oxazepam and lorazepam (and perhaps alprazolam) are the benzodiazepines of choice for elderly patients.
Long-term use of benzodiazepines should be discouraged because of the risk of dependence, which is a serious problem in the elderly. Unrecognised and untreated benzodiazepine dependence can lead to serious medical complications.
Benzodiazepines can impair cognition, mobility, and driving skills in older people, as well as increase the risk of falls. A recent study also found an association between benzodiazepine use in older people and increased risk of Alzheimer’s disease.
However, elderly patients are more likely to have confusion and severe drowsiness, or age-related heart, liver, or kidney problems, which may require caution and an adjustment in the dose for patients receiving clonazepam.
However, elderly patients are more likely to have unwanted effects (eg, severe drowsiness, dizziness, confusion, clumsiness, or unsteadiness) and kidney, liver, or lung problems, which may require caution and an adjustment in the dose for patients receiving this medicine.
In some populations, such as the children and the elderly, Ativan can cause a “paradoxical effect.” Instead of having a calming effect, it may cause agitation and confusion. Elderly patients taking Ativan are also at a higher risk of falls.
Generally speaking, when used as directed under supervision from a doctor, benzodiazepines are relatively safe for short periods of time. They are not, however, meant to be taken for longer than a few weeks to a few months at most.
The risk of overdose is particularly great when combined with sedative drugs such as opioids or alcohol. For these reasons, if used, benzodiazepines generally should not be prescribed continuously for more than one month.
Some non-addictive alternatives to benzodiazepines for anxiety available by prescription include:
Buspirone is an anti-anxiety drug that has been shown to be effective for older adults. Benzodiazepines, another anti-anxiety drug, are effective but should be prescribed carefully to older adults because of risk of memory impairment, unsteadiness, and falls.
Here are some common medications from the Beers list that senior citizens should avoid: Valium (diazepam). This sedative, often used to treat insomnia and anxiety, is involved in many inappropriate prescriptions for the elderly.