Abstract
Background: Benzodiazepines remain frequently prescribed in older adults despite long-standing concerns regarding their safety. Age-related pharmacokinetic and pharmacodynamic changes, combined with increased sensitivity of the central nervous system, may amplify adverse effects. This narrative review aims to summarize current evidence on the risks associated with long-term benzodiazepine use in geriatric populations and to outline contemporary clinical recommendations for deprescribing.
Results: Long-term benzodiazepine use in older adults is consistently associated with an increased risk of adverse outcomes, particularly falls and fractures, impaired cognitive function, and delirium. Evidence regarding dementia risk remains inconclusive, with observational studies suggesting a possible association, though confounding by indication cannot be excluded. Concomitant use with opioids significantly increases the risk of respiratory depression and mortality. Major clinical guidelines, including Beers Criteria and STOPP/START criteria, strongly recommend avoiding benzodiazepines in older adults, except for specific short-term indications. Deprescribing strategies, including gradual dose tapering and substitution with non-pharmacological interventions such as cognitive behavioral therapy for insomnia (CBT-I), have demonstrated effectiveness in reducing long-term use.
Conclusions: Current evidence indicates that long-term benzodiazepine use in geriatric patients is associated with significant and potentially preventable harms. Despite this, inappropriate prescribing remains common in clinical practice. Structured deprescribing strategies and increased adherence to clinical guidelines are essential to improving patient safety in older populations.