Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor
Copyright 1999 American Medical Association. All Rights Reserved.
Applicable FARS/DFARS Restrictions Apply to Government Use.1999
In Reply: My comments should not be taken as
support for inappropriate use of benzodiazepines in the elderly. I agree that
cognition-impairing medications should not be given to an older patient if
effective alternatives are available.
The rational use of benzodiazepines in elderly patients requires an
appreciation of the pharmacology of these compounds as well as an appraisal
of their risk vs benefit. There is no evidence that long-term use produces
tolerance to the anxiolytic effects or leads to escalation in dose. The cognitive
impairment produced by benzodiazepines, although measurable in laboratory
tests, is often clinically insignificant when low therapeutic doses are used.
Many older patients who take benzodiazepines regularly find the medications
useful and are not troubled enough by cognitive impairment to wish to discontinue
the drugs.1 There is little doubt, furthermore,
that untreated chronic anxiety and sleep disturbance in the elderly may contribute
to cognitive impairment and social dysfunction.2
Salzman C. Should Benzodiazepines in an 87-Year-Old Woman Be Tapered and Discontinued?—Reply. JAMA. 1999;282(12):1128. doi:10-1001/pubs.JAMA-ISSN-0098-7484-282-12-jbk0922