From the Guidelines
All benzodiazepines are on the Beers Criteria list and should generally be avoided in older adults (65 years and older). These include alprazolam, chlordiazepoxide, clonazepam, clorazepate, diazepam, estazolam, flurazepam, lorazepam, oxazepam, quazepam, temazepam, and triazolam. The Beers list specifically highlights concerns about benzodiazepines due to their increased sensitivity in older adults and prolonged half-life of long-acting agents. These medications increase the risk of cognitive impairment, delirium, falls, fractures, and motor vehicle accidents in older adults. If a benzodiazepine must be used in an older adult, shorter-acting options at the lowest effective dose for the shortest duration possible are preferred, though all carry risks. Non-pharmacological approaches for anxiety and insomnia should be considered first, and if medication is necessary, alternative agents with better safety profiles in older adults might be more appropriate, as noted in the most recent guidelines 1.
Key Points to Consider
- The American Geriatrics Society Beers Criteria list of potentially inappropriate medications in older adults includes all benzodiazepines due to their potential for adverse effects such as cognitive impairment, delirium, and falls 1.
- The use of benzodiazepines in older adults should be cautious, considering their increased sensitivity and the risk of prolonged sedation, especially with long-acting agents 1.
- Alternative approaches, including non-pharmacological methods for managing anxiety and insomnia, should be prioritized in older adults to minimize the risks associated with benzodiazepine use 1.
- When benzodiazepines are necessary, selecting shorter-acting options at the lowest effective dose for the shortest duration is recommended to mitigate risks, as suggested by recent clinical guidelines 1.
Recommendations for Practice
- Avoid benzodiazepines in older adults whenever possible due to their potential for adverse effects.
- Consider non-pharmacological approaches as the first line of treatment for anxiety and insomnia.
- If benzodiazepines are necessary, use shorter-acting options at the lowest effective dose for the shortest duration possible.
- Monitor patients closely for signs of adverse effects, including cognitive impairment, delirium, and falls, and adjust treatment plans accordingly, based on the latest evidence 1.
From the Research
Benzodiazepines on Beers List
- The American Geriatrics Society (AGS) Beers Criteria® for Potentially Inappropriate Medication (PIM) Use in Older Adults includes a list of benzodiazepines that are typically best avoided by older adults in most circumstances 2.
- However, the provided study does not specify which benzodiazepines are on the Beers list.
- Another study discusses the uses, dangers, and clinical considerations of benzodiazepines, but does not provide information on the Beers list 3.
- The Beers list is an explicit list of PIMs that are typically best avoided by older adults, but the specific benzodiazepines on the list are not mentioned in the provided studies.
- To determine which benzodiazepines are on the Beers list, it would be necessary to consult the AGS Beers Criteria® directly 2.