Benzodiazepines and the elderly. A review of potential problems

This article reviews the literature describing the extent of benzodiazepine use and abuse in the elderly and specific problems attendant upon this use, Unrecognized, undocumented use and abuse of psychoactive drugs is frequent in this population and can lead to serious problems with untreated dependence and withdrawal. The elderly appear to be more sensitive to the effects of benzodiazepines, both because of changed pharmacokinetics and pharmacodynamics with aging and because of altered postreceptor cerebral response. All problems identified with benzodiazepines such as dependence, withdrawal, and cognitive and psychomotor impairment are proportionally greater among the elderly, who can least afford these risks. Review of the literature leads to the conclusion that benzodiazepine prescribing for the elderly should be undertaken with the greatest caution and only with the recognition of all potentially disastrous effects.