Hypnotic drugs, psychomotor performance and ageing

This review examines studies, reported since 1976, in which the residual effects of hypnotic drugs on psychomotor performance have been evaluated in older people. The 33 studies involved a total of 934 subjects (aged 60-96 y), evaluated 21 different products, utilized 26 test procedures, and reported 169 drug versus placebo (or drug versus drug) comparisons, of which 42 were associated with significant residual impairment. While performance decrements were more associated with longer half-life drugs, repeated dosing, and frailty, these characteristics were often unreliable in predicting outcome. Significant improvements in performance were rare, and usually consistent with practice effects. While this literature provides a useful basis for clinical caution, it is not characterized by experimental rigour, and provides little or no empirical basis for predicting those real-life skills most likely to be affected. Issues of subject selection, experimental design, testing strategies, and data analysis need to be addressed if the risks and benefits of hypnotic drug use in later life are to be more clearly understood.