34 - Use of benzodiazepines in the aging population: do the benefits outweigh the risks?

Summary

This chapter reviews the benzodiazepines and the "z-drugs", zopiclone, zolpidem, and zaleplon under the pharmacological rubric of "benzodiazepinereceptor agonists" (BDZras). It analyzes whether the risks of the BDZras outweigh the benefits in the elderly. The chapter explains how the risks relate to the severity of the disorder, namely primary insomnia. The importance of insomnia in the elderly has been stressed. The chapter focuses on the treatments states that the adverse effects of benzodiazepine receptor agonists appear to be worse in the elderly. Adverse events were categorized as cognitive (memory loss, confusion) and psychomotor (dizziness, loss of balance, and morning hangover effects). The hypnotic drugs may contribute to falls and fractures in the elderly. Even small doses can cause acute confusional states, night-time wandering, and, occasionally, paradoxical excitement. Treatment-related impairment of memory and cognitive function may be wrongly diagnosed as features of dementia.