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Benzodiazepine Misuse in the Elderly: Risk Factors, Consequences, and Management

  • Anxiety Disorders (A Pelissolo, Section Editor)
  • Published:
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Abstract

Benzodiazepine (BZD) inappropriate use (i.e., misuse and overuse) is a worldwide public health problem. Despite current knowledge about increased sensitivity to side effects in the elderly, that should lead to more caution, only a third of BZD prescriptions in this age group are considered appropriate. The most frequent inadequate situations are excessive duration and/or dosage of a medical prescription or self-medication, especially in a context where it would be contraindicated, e.g., long-acting BZD in the elderly. Polypharmacy and comorbidities are major risk factors. Consequences of BZD inappropriate use are falls, delirium and other cognitive dysfunction, acute respiratory failure, car accidents, dependence, and withdrawal symptoms. An emerging concern is a potentially increased risk of dementia. Contrary to most clinicians’ belief, discontinuation of chronic BZD use in elderly patients is feasible, with adequate psychotherapeutic or pharmacological strategies, and can lead to long-term abstinence. Brief cognitive therapy mostly relies on psychoeducation and motivational enhancement and is particularly useful in this context. Further research is needed, notably in three areas: (1) assessing the impact of public health programs to prevent BZD inappropriate use in the elderly, (2) developing alternative strategies to treat anxiety and insomnia in elderly patients, and (3) exploring the association between chronic BZD use and dementia.

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Acknowledgments

A special thank you to Dr. Michelle Riba and Dr. Louis Trevisan for taking the time to review this manuscript.

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Correspondence to Guillaume Airagnes.

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Guillaume Airagnes, Antoine Pelissolo, Mélanie Lavallée, and Martine Flament declare that they have no conflict of interest.

Frédéric Limosin has received personal fees from Astra Zeneca, Euthérapie-Servier, Janssen Cilag, Lundbeck, Otsuka Pharmaceuticals France, and Roche.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Anxiety Disorders

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Airagnes, G., Pelissolo, A., Lavallée, M. et al. Benzodiazepine Misuse in the Elderly: Risk Factors, Consequences, and Management. Curr Psychiatry Rep 18, 89 (2016). https://doi.org/10.1007/s11920-016-0727-9

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  • DOI: https://doi.org/10.1007/s11920-016-0727-9

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