Physician rationale for benzodiazepine prescriptions to elderly hospitalized patients

The authors (within 24 hours of the order) administered a telephone questionnaire to physicians prescribing benzodiazepines to patients over age 65 admitted to a tertiary care university hospital (N = 81 consecutive medical and surgical admissions). Data were obtained from 50 physicians. Prescriptions were most commonly written for preoperative relaxation (26%), pain (14%), nausea (12%), to aid intubation (12%), or facilitate a medical test (10%). Dosages were chosen on the basis of subjective experience (32%), lowest effective dose (28%), considerations of age/sex/weight (16%), and drug manual recommendations (8%). Ten percent of patients were prescribed a benzodiazepine before hospitalization, and their dosages were tapered (6%) or maintained (4%). There is considerable variation in physicians rationale for benzodiazepine prescriptions to hospitalized elderly patients. Benzodiazepines are used to treat symptoms rather than disorders. Age is infrequently considered in dosing judgments despite the pharmacodynamic and pharmacokinetic changes known to be associated with aging.