Pharmacotherapy of Benzodiazepines in the Aged Patient

Since the introduction of chlordiazepoxide in 1961, benzodiazepines (BZDs) are the most commonly prescribed medications in anxiety and insomnia (as well as their use in a large variety of other pathologies), in spite of a limited number of studies showing their efficiency for these two indications. It has been shown that the utilisation of these medications in aged patients represents 27% of the whole prescription treatment whereas the aged patients represent only 14% of the population. Otherwise, BZDs represent 38% of hypnotic prescriptions in the United States (1,2). Despite the very large utilisation of BZDs, there is evidence to suggest that anxious disorders and insomnia are at times under-diagnosed and undertreated in aged patients (3). This poses the problem of their vast and very weak specificity of utilisation, which proves that these medications are relatively misused. Epidemiological studies show that among 25% of over 65 years old patients are in old folks residences and are often treated with BZDs. The anxious disorders are typically chronic disorders with remission periods and may be exacerbated stressful events. Few quality of life studies concerning aged people have been performed, although anxious symptoms have been associated with a mortality increase, all causes disconcerted and notably sudden cardiac deaths. It is also known that anxious people use the medical services more that others (4). BZDs treatment efficiency and its impact on longevity, quality of life and utilisation of services in aged patients suffering with anxious disorders are not well known. Recently, BZDs have been prescribed to treat behavioural disorders associated with dementia (5). These behavioural disorders can appear in more than 75% of patients suffering with dementia living in retirement homes and more than half of them show two, or more, problematic behaviours. Few short or long term BZDs efficiency studies concerning sleeping problems and/or behavioural associated dementia symptoms in aged patients exist. Most of the studies included non-benzodiazepine molecules like meprobamate, barbiturates and antihistaminergics. ABSTRACT: PHARMACOTHERAPY OF BENZODIAZEPINES IN THE AGED PATIENT