Benzodiazepine Use in Older Adults – Dangers Management and Alternative Therapies
Benzodiazepines are powerful sedatives that are effective at treating anxiety and sleep issues, by increasing the effectiveness of GABA (an endogenous chemical produced in your brain) to block communication between neurons.
Long-term use increases risks of addiction and withdrawal symptoms. Furthermore, prolonged usage impairs cognition and can increase risks such as falls, fractures and car accidents in older adults.
1. Benzodiazepine Withdrawal Symptoms
Long-term use of benzodiazepines like Ativan (lorazepam), Xanax (alprazolam), Klonopin (clonazepam), Valium (diazepoxide) and Librium (chlordiazepoxide) puts older adults at increased risk for adverse side effects, including addiction, depression and memory, coordination and attention issues as well as increases risk for hip fracture from falls or car accidents. Alternative treatments like improved sleeping habits or therapy for anxiety may work just as effectively; they just require more effort from both patients or caregivers involved.
As soon as benzodiazepines are used frequently and for extended periods, your brain becomes dependent upon them and withdrawal symptoms may appear when stopping taking them suddenly or decreasing dosage. Withdrawal symptoms usually start shortly after cutting back or stopping taking the drug altogether and can last several days – including rapid heartbeat, sweating, high blood pressure, tremors and shaking as well as hallucinations, confusion and agitated behavior.
Medical detox can make withdrawal much simpler and safer, lowering your risks of relapse significantly. It typically involves gradually decreasing prescription strength or tapering off altogether; additionally, doctors can provide other medications to manage withdrawal symptoms or help prevent relapse.
Some individuals experience protracted withdrawal symptoms that last months or years. Although not as well-studied as traditional withdrawal syndrome, protracted withdrawal may still have severe repercussions and include anxiety, nervousness and concentration difficulties.
Doctors should encourage patients to have conversations about benzodiazepine use and its impact. The Management of Benzodiazepine Use in Older Adults Tool contains tips on how to broach this subject with patients as well as links to relevant resources, services, and supports for older adults who take these medications. Sharing patient material such as this has proven highly successful at encouraging older adults to discuss their usage as well as review their prescriptions regularly.
2. Benzodiazepine Overdose
Benzodiazepine overdose among older adults is far more prevalent than one might suspect, often the result of polydrug use, where people mix benzos with alcohol or opioids and increase the risk of overdose and death significantly. When considering benzo overdose it’s essential to monitor for symptoms such as drowsiness, confusion, blurred vision, tremor (shaking), respiratory depression, slow heart rate or coma – even if someone only took their prescribed dosage of benzos.
Older patients are particularly at risk of overdose because their bodies process benzodiazepines more slowly, increasing the chances of build-up and potentially toxic side effects if taken in large quantities. Therefore, it’s vital that older patients who take long-acting benzos be monitored closely in order to detect any overdose symptoms early.
Overdose on benzodiazepines may also result in impaired cognitive functioning. According to multiple studies, long-term use of benzodiazepines was associated with moderate to severe impairments to memory and other aspects of cognition – most commonly including decreased IQ scores, visuospatial memory deficits, information processing issues and verbal learning impairments.
This poses a serious problem as doctors continue to prescribe these medications widely to older adults. Therefore, it is vital that patients be educated about the potential dangers of overdose with these drugs, and provided alternative ways of managing anxiety. Physicians should offer to taper long-term users as safely and gradually as possible in order to alleviate withdrawal symptoms; interventions which require minimal time from physicians could help achieve this result. Various alternative pharmacological and non-pharmacological options exist to treat insomnia and anxiety without resorting to benzodiazepines altogether – saving both parties valuable money as well.
3. Benzodiazepine Interactions
Benzodiazepine (benzos) medications can help relax and sleep better, but their long-term use can be dangerous. Overdosage may cause physical dependence and withdrawal symptoms when suddenly stopped; they also increase risk for falls and car accidents among older adults as well as impair cognitive function leading to dementia; they interact with many medications which is why it should be avoided as much as possible.
Despite warnings regarding benzodiazepine use in the United States, prescriptions have increased substantially between 2003 and 2015. More than 12.6 percent of Americans reported using prescription benzodiazepines within the past year for unapproved purposes, either more frequently than prescribed or longer than necessary, sometimes in conjunction with opioid medications or other forms of substance use such as cannabis.
Doctors frequently prescribe benzodiazepines for anxiety, insomnia and seizures. The drug possesses three primary effects: anxiolytic, hypnotic and sedative. Alprazolam, diazepam and lorazepam are commonly prescribed benzodiazepines with different elimination half-lives; triazolam appears to be particularly potent but may increase tolerance, dependence and withdrawal reactions when abruptly stopped.
This article highlights that while physicians may provide valid reasons for prescribing benzodiazepine to elderly patients, these drugs can be highly hazardous when given in long-term doses. Accordingly, medical and psychiatric organizations should promote alternatives to pharmaceutical treatment such as psychotherapy, nonpharmacological strategies and sleep restriction-sleep compression therapy as alternatives for treating elderly patients with insomnia. Judicious deprescribing should also be encouraged – which involves reviewing patient histories to ascertain whether their drug needs still apply or deprescribing them altogether.
4. Benzodiazepine Abuse
Benzodiazepines such as Ativan (lorazepam), Xanax (alprazolam), Klonopin (clonazepam), Valium (diazepoxide) and Librium (chlordiazepoxide) are sedative medications with a high potential risk of misuse, including dependence and addiction which may cause withdrawal symptoms such as seizures – in extreme cases this drug abuse may even prove lethal.
Healthcare providers and patients are well aware of the dangers associated with long-term use of benzodiazepine medications, yet prescription rates continue to climb despite warnings. According to one recent study from JAMA Psychiatry, adults aged 65 or over show higher rates of long-term benzodiazepine use.
Benzos can have devastating effects on the respiratory system, decreasing breathing and increasing risk of suffocation and death. Furthermore, they can induce drowsiness and slow reaction times leading to increases in falls and fractures as well as cognitive impairment leading to dementia or even delirium.
Importantly, it should also be remembered that benzodiazepine can interact with other medications and be particularly hazardous if taken with opioid painkillers such as oxycodone or hydrocodone, intensifying their effects and potentially leading to life-threatening side effects. The most frequently seen interactions involve benzos being taken in combination with these opioid painkillers – in this instance it could result in life-threatening consequences.
As there are safer alternatives to benzodiazepines for anxiety and insomnia in older adults, it’s essential for providers to recognize misuse and abuse in their patients. This can be accomplished through patient education programs, reduced new prescriptions for benzos, or deprescribing existing ones. CGPR has developed a tool designed specifically to assist providers in recognizing benzo users with medications lists, talking points and links to resources services and supports; encouraging patients to talk openly with their provider about benzo use as well as alternative treatment options
5. Benzodiazepine Overdose
Though rare, benzodiazepine overdose is possible. When too many pills of any sort are consumed together or when combined with other substances, the consequences could include coma or even death. Therefore, it’s vital that loved ones recognize the signs of overdose in order to assist their loved one should help become necessary.
Benzodiazepine is used as an anesthetic during medical procedures and to relieve anxiety. Additionally, it serves as a sedative to treat sleep disorders and relax muscle tension; however long-term use may lead to addiction and physical dependence in older adults, along with serious side effects like depression, drowsiness, poor memory retention, reduced libido and decreased sexual desire. Furthermore, interactions can occur with other medications and even worse when mixed with alcohol – potentially dangerous.
Studies indicate that individuals who have taken benzodiazepines for longer than a few weeks are at increased risk of Alzheimer’s disease, yet benzodiazepines remain one of the most prescribed medications among older Americans.
Even when physicians and healthcare systems attempt to reduce patients’ use of benzodiazepine medication, it can be challenging for patients to stop. Researchers have observed that older patients tend to respond well to efforts by physicians and health care systems to deprescribe other medications in order to simplify their regimens; however they resist attempts by health care systems or physicians to decrease benzodiazepine use; some reasons include fear that anxiety will return; confusion regarding long-term risks; and concerns that cutting doses might worsen their anxiety.
To address this issue, the CSMH has designed a tool to assist providers in managing the use of benzodiazepine among older adults. It includes helpful talking points, downloadable patient postcards, links to community resources and services supporting elderly populations and information on community support for elderly. Providing this information to rostered patients has shown to increase discussions about appropriate use as well as encourage chronic consumers to discontinue excessive consumption.