Weekly blog -- Harms of benzodiazepines in the elderly...

In Choosing Wisely,  The Canadian Geriatrics Society advised physicians and patients to refrain from using benzodiazepines as first-line treatment for insomnia in older adults (link). 

To quote them:

"The number needed to treat with a sedative-hypnotic for improved sleep is 13, whereas the number needed to harm is only 6"

Adverse events include:

• Cognitive impairment (link)

• Hip Fracture
• In this cohort study there was a 10-40% increased rate of hip fracture in users of sedative-hypnotics including benzodiazepines and non-benzo sedative hypnotics (link).  
• Shockingly the population attributable risk may be as high as 8.2%! (link)
• Respiratory events in patients with chronic lung illnesses
• In this cohort (Ontario) patients with COPD who received benzos had an increased rate of adverse respiratory events (link)
• Increased risk of death in this population (link)
• All cause mortality:
• In this cohort, sleeping pills were associated with a 3 fold increase of death (link).
• Similar effect size in this cohort (link)... 4 deaths per 100 people over 7.6 years.
• Pneumonia and death in age <60 (link)
• Car accidents
• FDA advisory of sedative/hypnotics and car accident risk (and need to reduce dose) (link)

Below is a must read for those who are interested in reducing benzodiazepine use in the frail elderly...I think it is a real example of success in intervening against potentially (probably) inappropriate prescription drug use.

Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial 

(And yes, before anyone sends me angry emails, I know that maybe INSOMNIA is associated with all of these adverse events and that the sedatives may be the "innocent bystander"...  To you, I can only say, "primun non nocere"... Show me the randomized controlled trial...)