Benzodiazepines and Nonbenzodiazepines: The Most Common Potentially Inappropriate Medications in Old

The use of benzodiazepines and nonbenzodiazepines in the elderly is of very serious concern, especially when it comes to driving.

Not only have benzos been shown to increase the risk of Alzheimer’s Disease (by 32% to 84% depending on the study) and hip fractures from falls (by as much as 40% in some groups) along with other side effects and risks in the elderly, they also can inhibit senior citizens ability to drive motor vehicles. A study released in November 2018 by the AAA’s Foundation for Traffic Safety stated that the use of potentially inappropriate medication (PIMs) in older drivers is common.

Use of PIMs is fairly common in older drivers and often involves medications known to impair driving ability and increase crash risk. In order to improve traffic safety among older drivers, drivers should be aware of the types of medications they are taking to ensure optimal safety behind the wheel. — Prevalance of Potentially Inappropriate Medication Use in Older Drivers: AAA LongROAD Study

The most common PIMs according to the study are benzodiazepines (16.6%) and nonbenzodiazepines (16.4%) followed by antidepressants (15.2%) and first-generation antihistamines (10.5%). Since there are 42 million adults aged 65 and older on America’s roads, the number of drivers who could be driving in a diminished capacity based on these drugs could be in the millions. The American Geriatrics Society (AGS) Beers Criteria includes a strong recommendation to avoid any type of benzodiazepine for the treatment of insomnia or agitation in the elderly and it identifies the use of benzodiazepines as one of 10 things physicians and patients should question.

This is not a new concern. Some medical professionals have been voicing concern about the detrimental effects of benzos on the elderly for decades.

Especially troubling is that benzo use is ridiculously high (nearly one out of ten) in the elderly, the group most likely to be harmed by them…If you meet an elderly patient who seems dopey, confused, has memory loss, slurred speech, and poor balance, your first thought should be benzo side effects — not Alzheimer’s disease or dementia. — Dr. Allen Frances, Professor Emeritus at Duke University, Chairman of the DSM-IV Committee

Older people are more sensitive than younger people to the central nervous system depressant effects of benzodiazepines. Benzodiazepines can cause confusion, night wandering, amnesia, ataxia (loss of balance), hangover effects and “pseudodementia” (sometimes wrongly attributed to Alzheimer’s disease) in the elderly and should be avoided wherever possible. — The Ashton Manual, Prof. C. Heather Ashton

Benzos slow down the workings of the brain and muscles, which increases the risk of motor vehicle crashes. These side effects often ease over time, but since benzodiazepines should only be taken on a short-term basis, there shouldn’t be an “over time.”

Older drivers are highly encouraged to bring a list of medications to their next doctor appointment, including prescriptions, over-the-counter medications, vitamins, and supplements, and discuss their concerns with their physicians.

You can read the entire AAA LongROAD Study at the following link: https://publicaffairsresources.aaa.biz/wp-content/uploads/dlm_uploads/2018/11/18-0709_AAAFTS-PIMS-Brief_r2.pdf

by D E Foster

References

1. Andrews, H.F., M.E. Betz, S. Chihuri, C. DiGuiseppi, D.W. Eby, A. Gordon, L.L. Hill, V. Jones, B.H. Lang, C.S. Leu, G. Li, D.P. Merle, T.J. Mielenz, L.J. Molnar, D. Strogatz. (2018). “Prevalence of Potentially Inappropriate Medication Use in Older Drivers: A LongROAD Study.” AAA Foundation for Traffic Safety. Accessed December 5, 2018. https://publicaffairsresources.aaa.biz/wp-content/uploads/dlm_uploads/2018/11/18-0709_AAAFTS-PIMS-Brief_r2.pdf.

2. Ashton, C. Heather. Benzodiazepines: How They Work and How to Withdraw (aka The Ashton Manual). 2002. Accessed April 13, 2016. http://www.benzo.org.uk/manual.

3. Foster, D E. Benzo Free: The World of Anti-Anxiety Drugs and the Reality of Withdrawal. Erie, Colorado: Denim Mountain Press, 2018. https://easinganxiety.com/book.

4. Frances, Allen. “Yes, Benzos Are Bad for You.” Pro Talk: A Rehabs.com Community, June 10, 2016. Accessed October 13, 2016. https://www.rehabs.com/pro-talk-articles/yes-benzos-are-bad-for-you/.

5. Pariente, Antoine, Sophie Billioti de Gage, Nicholas Moore and Bernard Bégaud. “The Benzodiazepine–Dementia Disorders Link: Current State of Knowledge.” CNS Drugs 30(1)(January 2016):1-7. Accessed December 12, 2016. doi:10.1007/s40263-015-0305-4.

6. Saarelainen, Laura, Anna-Maija Tolppanen, Marjaana Koponen, Antti Tanskanen, Jari Tiihonen, Sripa Hartikainen and Heidi Taipale. “Risk of Death Associated with New Benzodiazepine Use Among Persons with Alzheimer’s Disease — a Matched Cohort Study.” International Journal of Geriatric Psychiatry (November 15, 2017). Accessed April 8, 2018. doi:10.1002/gps.4821.

7. Sax, Lindsay. “Medications increase crash risk by 300%.” KOAA News 5. December 4, 2018. Accessed December 5, 2018. https://koaa.com/news/covering-colorado/2018/12/04/medications-increase-crash-risk-by-300/.