Barbiturates should be avoided as a sleep aid in older adults because they are:

• A. Avoided as first-line due to dependence risks.
• B. Recommended as first-line sleep aids.
• C. Safest option for sleep in older adults.
• D. Preferred to treat anxiety.

Answer: (A)

Barbiturates are avoided in older adults as sleep aids because they carry a high risk of dependence and adverse effects. They tend to produce tolerance and withdrawal, and their sedative effects can cause confusion, delirium, and impaired coordination, which increases the risk of falls and fractures. Aging diminishes drug clearance and increases sensitivity, so the effects last longer into the next day. For these safety reasons, they are not used as first-line sleep therapy; safer options and nonpharmacologic approaches are preferred. They’re also not a good choice for anxiety-related sleep issues due to similar dependence and sedation concerns.