Benzodiazepine Usage and Its Implications in Older Adults
Summary
Benzodiazepines are widely prescribed for anxiety, insomnia and muscle spasticity but pose particular challenges in older adults due to age-related changes in drug metabolism and sensitivity. Long-term use is associated with cognitive impairment, daytime sedation, impaired balance and an elevated risk of falls and fractures. Dependence can develop within weeks, complicating discontinuation efforts and contributing to withdrawal syndromes. Observational studies have also linked chronic benzodiazepine exposure to increased all-cause mortality. Clinical guidelines emphasise the lowest effective dose for the shortest duration, regular medication review and consideration of non-pharmacological therapies. Deprescribing strategies—including gradual dose reduction, patient education and psychological support—have shown variable success. Globally, high prevalence rates among those aged over 65 have prompted policy and educational initiatives aimed at safer prescribing, risk stratification and the development of alternative treatments to mitigate harm in this vulnerable population.
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Benzodiazepine Usage and Its Implications in Older Adults publication trend
The graph below shows the total number of articles in benzodiazepine usage and its implications in older adults across all publications each year (not limited to Nature Index journals).
Technical terms
Benzodiazepines: A class of central nervous system depressants that enhance the effect of the inhibitory neurotransmitter GABA, used for anxiolysis, sedation and muscle relaxation.
Half-life: The interval required for a drug’s plasma concentration to decline by 50 %, affecting duration of action and accumulation, particularly in older individuals.
Coprescribing: The concurrent prescription of two or more medications, which may elevate the risk of pharmacodynamic interactions and adverse events.
Nested case–control study: An observational design in which cases of a specific outcome are compared with matched controls drawn from the same cohort, enabling efficient estimation of relative risks.
Hip fracture: A break in the proximal femur frequently resulting from falls in older adults and associated with significant morbidity, mortality and healthcare utilisation.
References
- Risk of hip fracture among older people using anxiolytic and hypnotic drugs: a nationwide prospective cohort study. European Journal of Clinical Pharmacology (2014).
- Association of benzodiazepine and Z-drug use with the risk of hospitalisation for fall-related injuries among older people: a nationwide nested case–control study in Taiwan. BMC Geriatrics (2017).
- Effect of anxiolytic and hypnotic drug prescriptions on mortality hazards: retrospective cohort study. The BMJ (2014).
- Deprescribing benzodiazepines and Z-drugs in community-dwelling adults: a scoping review. BMC Pharmacology and Toxicology (2015).
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