Prescribing Benzodiazepines for Older Adults: Factors to Consider

(Part 4 of 4)

In this video, geriatric psychiatrist Marc E. Agronin, MD, talks about factors clinicians should consider before prescribing benzodiazepines for older adults. Dr. Agronin is the senior vice president for Behavioral Health and chief medical officer for MIND Institute at Miami Jewish Health in Florida.

Dr. Agronin presented "The Top Dos and Don’ts in the Psychopharmacologic Treatment of Geriatric Patients: Focus on Dementia and Late-Life Depression and Anxiety" at the virtual Psych Congress 2020 conference.

Read the transcript:

Benzodiazepines are commonly used in young and old individuals for a variety of different reasons, mostly for acute anxiety and for panic, and there's a good reason why they're used so commonly. They work quickly. They often work quite well.

For someone who's really suffering with acute anxiety, a panic attack, agitation, these are often going to be the go-to medications because when we see someone in such pain, we want to help them quickly, and there's nothing wrong with that. They work well, and they all tend to work in very similar manners.

The problem is that in older individuals, they can be more sensitive to the impact of that. For instance, we know that benzodiazepines in older individuals increase the risk of falling with fractures by 20 to 50 percent. They can cause excess sedation, cognitive deficits. We know that older individuals taking benzodiazepines have higher rates of motor vehicle accidents, and in fact, mortality rates are 1.2 to roughly 3.7 times higher in older individuals on benzodiazepines.

It doesn't mean we shouldn't use them. It means we need to be very cautious and make certain that you have a specialist involved who's managing the underlying anxiety or other symptoms that you're trying to treat with benzos.

Always be cautious of whether they're being mixed with pain medications, especially opiates, other sleeping pills, other medications that can have depressant effects on the central nervous system.

If you're using these medications, keep in mind that if there is an underlying anxiety disorder, these are meant for only short-term use.

We want to involve either antidepressant medications which are the mainstay treatment for all different forms of anxiety disorders, and/or that we're incorporating different forms of psychotherapy such as cognitive behavioral therapy, which is also very effective for anxiety disorders.

If they're being used for sleep, we want to incorporate educating the patient, and if there's a caregiver involved, on sleep hygiene, to understand “is there an underlying sleep issue?”.

This is so important because benzodiazepines, though they can work well, are really intended for short-term use or intermittent use.

We need to make certain that we're clearly getting at the underlying issue, we're treating it appropriately and thoroughly, and that will help us to minimize use of benzos, to use them only when needed, and to prevent some of the key side effects and safety issues that can arise with their use.

More with Dr. Agronin:
Improving Cognition in Patients With Alzheimer’s Disease
Adjusting Psychopharmacologic Treatment for Geriatric Patients
Prescribing Psychotropic Medications for Older Adults