The use of hypnotics and anxiolytics in the elderly

Anxiety and insomnia are prevalent conditions in the elderly, and anxiolytics and hypnotic drugs are commonly used. Pharmacokinetic variables--absorption, distribution, metabolism and elimination--are all altered to a greater or lesser extent. As a general rule, the elderly are more sensitive to psychotropic drug actions than younger patients. This is particularly so in the over 80s. The elderly tend to suffer from physical conditions which may cause insomnia and anxiety, and medication for those physical complaints may interact with psychotropic medication. In the treatment of insomnia, short- or intermediate-acting benzodiazepines are preferable to long-acting compounds which tend to accumulate and produce confusional states and ataxia. Similarly, the benefit/risk ratio for anxiolytics is least in the elderly. Compounds of intermediate half-life and no active metabolites, such as oxazepam, are preferable. Anxiety syndromes occurring in other contexts, e.g. dementia may be better treated with low doses of antipsychotic drugs.