Barbiturates (butalbital, phenobarbital, primidone) in older adults are:

• A. High in physical dependence with overdose risk at low doses.
• B. Effective and safe long-term for sleep in older adults.
• C. Have no withdrawal risk.
• D. Preferred for sedation in older adults.

Answer: (A)

Barbiturates are avoided in older adults because they carry a high risk of physical dependence and overdose, even at low doses. These drugs (butalbital, phenobarbital, primidone) depress the central nervous system strongly, and aging changes slow their clearance and increase sensitivity to their effects. That combination means daytime sedation, delirium, falls, cognitive impairment, and respiratory depression become more likely, and dependence with withdrawal can be severe if use is stopped abruptly. Because of these safety concerns, they are not considered safe or effective for long-term sleep or sedation in older adults. The other choices imply safety or no withdrawal risk, which contradicts the known risks of barbiturates in this population.