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Prescription Benzodiazepine Use Among Older Adults

A Critical Review

Gerlach, Lauren B., DO, MS; Wiechers, Ilse R., MD, MPP, MHS; Maust, Donovan T., MD, MS

doi: 10.1097/HRP.0000000000000190

Objectives Despite evidence for many potential risks, use of benzodiazepines (BZDs) among older adults is common. The authors evaluated the available evidence for BZD effectiveness and tolerability for use in older adults in three psychiatric conditions for which BZDs are commonly prescribed: insomnia, anxiety disorders, and behavioral and psychological symptoms of dementia.

Design Electronic databases, including PubMed/MEDLINE, were searched to identify articles that (1) included patients ≥50 years of age, (2) focused on patients diagnosed with insomnia, anxiety disorders, or behavioral and psychological symptoms of dementia, and (3) were either a randomized, placebo-controlled trial or a randomized trial comparing a BZD with either another psychotropic medication or psychotherapy.

Results Thirty-one studies met the inclusion criteria. Of the three clinical indications evaluated, treatment of insomnia had the greatest available evidence for use of BZDs among older adults, with 21 of 25 trials demonstrating improved sleep outcomes with use of BZDs. Only one trial was found to meet eligibility criteria for BZD use in anxiety disorders, demonstrating benefit over placebo. Five studies for use in behavioral disturbances in dementia were included, of which only one demonstrated improvement over placebo.

Conclusion This systematic review suggests that BZD prescribing to older adults is significantly in excess of what the available evidence suggests is appropriate. Future trials should focus on efforts to reduce both acute and chronic BZD use among older adults while improving access to effective non-pharmacologic treatment alternatives.

From the Department of Psychiatry, University of Michigan Medical School (Drs. Gerlach and Maust); Department of Psychiatry, School of Medicine, Yale University (Dr. Wiechers); Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs, West Haven, CT (Dr. Wiechers); Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI (Dr. Maust).

Supported by National Institute on Aging Beeson Career Development Award Program (NIA K08AG048321), American Federation for Aging Research, John A. Hartford Foundation, and Atlantic Philanthropies (Dr. Maust).

Original manuscript received 27 September 2017, accepted for publication subject to revision 20 November 2017; revised manuscript received 14 December 2017.

Correspondence: Lauren B. Gerlach, DO, University of Michigan–Department of Psychiatry, 4250 Plymouth Rd., Ann Arbor, MI 48109.

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© 2018 President and Fellows of Harvard College
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