From the Guidelines

Yes, benzodiazepines can increase confusion in the elderly.

Benzodiazepines can cause sedation, cognitive impairment, and unsafe mobility with injurious falls in the elderly, as stated in the Mayo Clinic Proceedings 1.
The American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication (PIM) use in older patient populations recommends avoiding benzodiazepines in older patients due to their increased sensitivity to all benzodiazepines and decreased metabolism of long-acting agents, which can lead to cognitive impairment, delirium, and falls 1.
Elderly patients are significantly more sensitive to the sedative effects of benzodiazepines, and benzodiazepine clearance is reduced in patients with hepatic dysfunction, other disease states, and when administered with other medications that inhibit cytochrome P450 enzyme systems and/or glucuronide conjugation in the liver 1.

Safer alternatives to benzodiazepines, such as psychological or pharmacological treatments, including antidepressants, cognitive-behavioral therapy, and integrative strategies, should be pursued 1.
A gradual reduction of benzodiazepines over many weeks can help reduce the risk of rebound or withdrawal, as demonstrated in the EMPOWER trial 1.
Education and self-empowerment can also be effective in tapering benzodiazepines, with studies showing success in older adults who are informed about the risks and benefits of benzodiazepine use 1.

From the Research

Benzodiazepines have been associated with an increased risk of confusion and cognitive impairment in elderly patients 2, 3, 4.
A study published in 1995 found that benzodiazepine use was a significant risk factor for cognitive impairment in elderly hospital inpatients, with an adjusted odds ratio of 3.5 4.
Another study published in 2016 found that benzodiazepine use was associated with a 78% higher risk of dementia in the elderly population 5.
The use of benzodiazepines in the elderly has been linked to a range of adverse effects, including falls, delirium, and other cognitive dysfunctions 2, 3, 6.
The pharmacokinetics and pharmacodynamics of benzodiazepines can be altered in the elderly, leading to increased sensitivity to their effects and a higher risk of adverse reactions 3, 6.

Polypharmacy and comorbidities are major risk factors for benzodiazepine-related problems in the elderly 2.
The use of benzodiazepines with long half-lives can lead to accumulation and increased risk of adverse effects 3.
Benzodiazepine withdrawal can also cause confusion and disorientation in elderly patients 3.
The consequences of benzodiazepine misuse in the elderly can be severe, including falls, acute respiratory failure, and car accidents 2.

Discontinuation of chronic benzodiazepine use in elderly patients is feasible and can lead to long-term abstinence 2.
Brief cognitive therapy and motivational enhancement can be useful in managing benzodiazepine use in elderly patients 2.
Alternative strategies for treating anxiety and insomnia in elderly patients should be considered, such as non-pharmacological interventions and other medications 2, 6.