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.
The increased sensitivity of older people to benzodiazepines is due to age-related alterations in the central nervous system receptors. It is likely that benzodiazepine receptors in the brain become more sensitive, causing increased sedation, unsteadiness, memory loss, and disinhibition.
BZDs increase the risk of falling when used either as monotherapy or in combined therapies. It is preferable to use short-acting BZDs, to avoid cumulative effects over time predisposing to falls. A high proportion of falls in older adults are related to the use of BZDs.
Benzodiazepines and Z-drugs are not recommended for long-term use (longer than 2 weeks), except in exceptional circumstances (e.g., for terminally ill patients). There is no evidence to support the long-term use of these drugs for insomnia or any mental health indication.
However, elderly patients are more likely to have unwanted effects (eg, severe drowsiness, dizziness, confusion, clumsiness, or unsteadiness) and age-related kidney problems, which may require caution and an adjustment in the dose for patients receiving diazepam.
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.
In one study, 19 percent of 2508 community-dwelling older adults were using one or more medications inappropriately; NSAIDs and benzodiazepines were the drug classes with the most potential problems [43].
But the risks—including dependency, addiction, increased accidents, and overdose—rise steeply with long-term use. An increasing number of organizations and agencies urge caution when prescribing these medications.
Avoid breastfeeding while taking benzos as they can make the baby too drowsy and interfere with effective feeding. Avoid abrupt discontinuation. If benzos are used habitually for an extended period of time, the patient should speak to their MD about tapering off the medication.
Benzodiazepines increase the risk of addiction, withdrawal, cognitive decline, motor vehicle crashes, and hip fracture. The risk of overdose is particularly great when combined with sedative drugs such as opioids or alcohol.
This meta-analysis pooled ten studies and found that BDZ significantly increases the risk of dementia in the elderly population. This effect was greater in patients using BDZ with a longer half-life (>20 hours half-life) and taking BDZ for a longer duration (>3 years).
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.
Benzodiazepines are lipid soluble medications that have a prolonged half life in the elderly because of accumulation in lipid tissue. Because of the extended duration of action and increased sensitivity to sedative hypnotics in the elderly, benzodiazepines can cause delirium.
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.
Benzodiazepines bind to a specific protein, the translocator protein (TSPO), on the surface of cell organelles of the microglia. This binding activates the microglia, which then degrade and recycle synapses—that is, the connections between nerve cells.
By using benzodiazepines for an extended time, there is an increased risk of the development of certain health conditions. The amount of time considered “long-term” in regard to benzodiazepine abuse is around three to six months.
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.
Benzodiazepines should be avoided in patients with a history of drug abuse. Common benzodiazepines used for GAD include alprazolam, clonazepam, diazepam, and lorazepam. Mirtazapine (Remeron) and buspirone are also effective in GAD for patients who do not respond to at least two trials of SSRIs or SNRIs.
You should only be prescribed benzodiazepines for the shortest amount of time possible. Taking benzodiazepines regularly for a few weeks or more can lead to addiction. Doctors recommend that you only take them for 2-4 weeks. Intermittent use may help to avoid addiction.
Long-term use of diazepam can lead to chemical dependency and, eventually, to severe addiction. Understanding the health complications of Valium addiction may encourage nonmedical users of this drug to reach out for help.
Hospitalization rates due to adverse drug effects are 4 times higher in older patients (about 17%) than in younger patients (4%). And 66% of these hospitalizations in older patients are due to 4 drugs or drug classes—warfarin, insulin, oral antiplatelet drugs, and oral hypoglycemic drugs.
Drugs Older Adults Should Use with Caution
Also, consider avoiding aspirin, ibuprofen, and naproxen entirely if you're older than 75, taking an oral steroid, or taking a prescription blood thinner. Heart failure or irregular heartbeat medication: digoxin (Lanoxin).