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Benzodiazepines in the elderly

Bandolier occasionally comes across an excellent review which is very difficult to précis. One such is a review of the benefits and risk of the use of benzodiazepines for insomnia for community-dwelling elderly from Ronald Grad in Montreal [1]. The highlights of the review are given below, but the full flavour of the evidence can only be conveyed by reading the paper. So our best advice is that if this is an issue of interest to you, it is worth requesting from your local library.

Benefits

There were 10 studies which met inclusion criteria for assessing benefit, none of which addressed the long-term effectiveness of benzodiazepines for treatment of sleep disorders in the elderly.

In sleep-laboratory settings, triazolam 0.125 mg, flurazepam 15 mg and estazolam 1 mg made people fall asleep about 30 minutes sooner than did placebo. They also increased total sleep time by 50 - 80 minutes for the first 2-3 nights.

Risk

Ten observational studies examined the relationship between benzodiazepines and adverse events like falls, car crashes and hip fracture. The larger studies (but generally not the smaller ones) showed that long-acting benzodiazepines (though not short acting benzodiazepines or sedative hypnotic drugs) were associated with an increased risk of hip fracture.

The overall risk was significant, but weak in magnitude - risk estimate 1.6 to 1.8. The public health perspective is that despite the small magnitude of the risk, the large number of elderly people given long-acting benzodiazepines for insomnia may be a cause of a significant minority of hip fractures.

Comment

The strength of the evidence here is weak. Grad makes enough of a point to consider avoiding the prescription of long-acting benzodiazepines for insomnia in the elderly.

Reference:

  1. RM Grad. Benzodiazepines for insomnia in community-dwelling elderly: a review of benefit and risk. Journal of Family Practice 1995 41: 473-81.



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