Benzodiazepine Use in Older Adults: Dangers, Management, and Alternative Therapies.
Several major medical and psychiatric organizations, including the American Geriatrics Society, advise against using benzodiazepines or nonbenzodiazepine hypnotics in older adults. Despite these recommendations, benzodiazepines continue to be massively prescribed to a group with the highest risk of serious adverse effects from these medications. This article summarizes legitimate reasons for prescribing benzodiazepines in the elderly, serious associated risks of prescribing them, particularly when not indicated, barriers physicians encounter in changing their prescription patterns, and evidence-based strategies on how to discontinue benzodiazepines in older patients. Although more research is needed, we propose several alternatives for treating insomnia and anxiety in older adults in primary care settings. These include nonpharmacological approaches such as sleep restriction-sleep compression therapy and cognitive behavioral therapy for anxiety or insomnia, and as well as alternative pharmacological agents.
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
Matej
M
Markota
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN. Electronic address: rummans.teresa@mayo.edu.
Teresa A
TA
Rummans
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
John Michael
JM
Bostwick
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
Maria I
MI
Lapid
D000058:Accidental Falls; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D001007:Anxiety / Q000628:therapy; D001569:Benzodiazepines / Q000008:administration & dosage / Q000009:adverse effects*; D003072:Cognition Disorders / Q000139:chemically induced; D015928:Cognitive Behavioral Therapy; D003692:Delayed-Action Preparations; D003704:Dementia / Q000139:chemically induced; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D050723:Fractures, Bone / Q000209:etiology; D006801:Humans; D057970:Inappropriate Prescribing; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D007319:Sleep Initiation and Maintenance Disorders / Q000628:therapy; D019966:Substance-Related Disorders / Q000523:psychology
D000928:Antidepressive Agents; D003692:Delayed-Action Preparations; D001569:Benzodiazepines