From the Guidelines
Benzodiazepines are on the Beers Criteria list because they pose significant risks to older adults, including increased sensitivity, decreased metabolism, and a higher risk of cognitive impairment, delirium, and falls, as recommended by the American Geriatrics Society with moderate quality of evidence 1. The Beers Criteria list specifically cautions against benzodiazepines due to their potential to cause excessive sedation, confusion, impaired balance, and respiratory depression in older adults. Key points to consider include:
- Increased sensitivity to benzodiazepines in older adults, leading to prolonged effects
- Decreased metabolism of long-acting benzodiazepines, further increasing the risk of adverse effects
- Higher risk of cognitive impairment, delirium, falls, fractures, and motor vehicle accidents associated with benzodiazepine use in older adults
- Potential for physical dependence and withdrawal symptoms, making discontinuation challenging For elderly patients requiring treatment for anxiety, insomnia, or agitation, non-pharmacological approaches should be tried first, followed by safer medication alternatives when necessary, as suggested by the ERAS society recommendations 1. If benzodiazepines must be used, they should be prescribed at the lowest effective dose for the shortest possible duration with close monitoring. Effective communication strategies, such as attending a preoperative educational session, can also help reduce patient anxiety and improve their perioperative experience 1.
From the Research
Benzodiazepines on the Beers List
- Benzodiazepines are included on the Beers list due to their potential for inappropriate use in older adults, as stated in the 2015 American Geriatrics Society (AGS) Beers Criteria 2 and the 2019 updated AGS Beers Criteria® 3.
- The Beers criteria aim to identify potentially inappropriate medications that should be avoided in older adults, and benzodiazepines are considered one of these medications due to their risks, such as physiological dependence and adverse effects 4.
- Research has shown that the use of benzodiazepines in older adults is associated with an increased risk of fracture, particularly with high doses and longer durations of use 5.
- Studies have also found that benzodiazepines are still widely used in older adults with anxiety disorders, despite the availability of alternative treatments such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) 6.
- The continued use of benzodiazepines in older adults may be due to their rapid onset of action and efficacy, as well as patient reluctance to taper off the medication 4.
- However, the risks associated with benzodiazepine use in older adults, including physiological dependence and adverse effects, highlight the need for careful consideration and monitoring of their use in this population 2, 3.