Benzodiazepines (such as diazepam, lorazepam, temazepam) in older adults should be avoided because they:

• A. Should be avoided due to risks including increased falls, delirium, and cognitive impairment.
• B. Are first-line for insomnia in older adults.
• C. Have no interaction with opioids.
• D. Are recommended for seizure disorders as first-line.

Answer: (A)

Older adults are more sensitive to central nervous system depressants, and benzodiazepines bring a combination of slowed reaction time, sedation, and cognitive effects that can be amplified in this population. As metabolism and drug clearance slow with age, these drugs (especially the longer-acting ones) can accumulate, increasing the risk of delirium, confusion, and steady sedation. This constellation raises the chance of falls and fractures, which are particularly dangerous for seniors. Because of these safety concerns, the Beers Criteria flags benzodiazepines as inappropriate for older adults, especially for insomnia or anxiety, and favors nonpharmacologic approaches or safer alternatives. They also can interact with opioids to worsen sedation and respiratory depression, and they are not considered first-line for seizures or for routine use in older patients.