Benzodiazepines can cause
- night wandering,
- ataxia (loss of balance),
- hangover effects and
- "pseudodementia" (sometimes wrongly attributed to Alzheimer's disease)
in the elderly and should be avoided wherever possible.
Increased sensitivity to benzodiazepines in older people is partly because they metabolise drugs less efficiently than younger people, so that drug effects last longer and drug accumulation readily occurs with regular use. However, even at the same blood concentration, the depressant effects of benzodiazepines are greater in the elderly, possibly because they have fewer brain cells and less reserve brain capacity than younger people.
For these reasons, it is generally advised that, if benzodiazepines are used in the elderly, dosage should be half that recommended for adults , and use (as for adults) should be short-term (2 weeks) only. In addition, benzodiazepines without active metabolites (e.g. oxazepam [Serax], temazepam [Restoril]) are tolerated better than those with slowly eliminated metabolites (e.g. chlordiazepoxide [Librium], nitrazepam [Mogadon]). Equivalent potencies of different benzodiazepines are approximately the same in older as in younger people.