title: Benzodiazepine Misuse in the Elderly: Risk Factors, Consequences, and Management.
abstract: Benzodiazepine (BZD) inappropriate use (i.e., misuse and overuse) is a worldwide public health problem. Despite current knowledge about increased sensitivity to side effects in the elderly, that should lead to more caution, only a third of BZD prescriptions in this age group are considered appropriate. The most frequent inadequate situations are excessive duration and/or dosage of a medical prescription or self-medication, especially in a context where it would be contraindicated, e.g., long-acting BZD in the elderly. Polypharmacy and comorbidities are major risk factors. Consequences of BZD inappropriate use are falls, delirium and other cognitive dysfunction, acute respiratory failure, car accidents, dependence, and withdrawal symptoms. An emerging concern is a potentially increased risk of dementia. Contrary to most clinicians' belief, discontinuation of chronic BZD use in elderly patients is feasible, with adequate psychotherapeutic or pharmacological strategies, and can lead to long-term abstinence. Brief cognitive therapy mostly relies on psychoeducation and motivational enhancement and is particularly useful in this context. Further research is needed, notably in three areas: (1) assessing the impact of public health programs to prevent BZD inappropriate use in the elderly, (2) developing alternative strategies to treat anxiety and insomnia in elderly patients, and (3) exploring the association between chronic BZD use and dementia.
authors.affiliation: AP-HP, Hôpitaux Universitaires Paris Ouest, Pôle Psychiatrie Addictions, Paris, France. guillaume.airagnes@aphp.fr.|Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France. guillaume.airagnes@aphp.fr.|Centre Ambulatoire d'Addictologie, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75908, Paris, Cedex 15, France. guillaume.airagnes@aphp.fr.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Airagnes
authors.affiliation: AP-HP, Service de Psychiatrie, Hôpital Henri-Mondor, Université Paris-Est Créteil, INSERM U955, IMRB, Fondation FondaMental, Créteil, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Pelissolo
authors.affiliation: Université Laval, Département de Psychiatrie et Neurosciences, Québec, Canada.|Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Québec, Canada.|Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Lavallée
authors.affiliation: University of Ottawa Institute of Mental Health Research, Royal Ottawa Mental Health Centre, Ottawa, Ontario, Canada.
authors.forename: Martine
authors.initials: M
authors.lastname: Flament
authors.affiliation: AP-HP, Hôpitaux Universitaires Paris Ouest, Pôle Psychiatrie Addictions, Paris, France.|Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France.|Inserm, U894, Centre Psychiatrie et Neurosciences, Paris, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Limosin
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000368:Aged; D001569:Benzodiazepines / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000139:chemically induced; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008875:Middle Aged; D063487:Prescription Drug Misuse / Q000706:statistics & numerical data*; D012307:Risk Factors
chemical_list: D006993:Hypnotics and Sedatives; D001569:Benzodiazepines
keywords: Benzodiazepine; Elderly; Hypnotic; Inappropriate use; Misuse; Overuse