The use of benzodiazepines has been associated with several adverse effects including, ataxia, dizziness, over-sedation, anterograde amnesia, and dependence. The severity of adverse effects, particularly those associated with the central nervous system, may be greater in older adults. Therefore, close monitoring is typically recommended when benzodiazepines are used by older adults. In addition, several reviews and guidelines recommend that the use of long-acting benzodiazepines by older adults be avoided. High utilization by older adults and documented safety concerns indicate that a review of the evidence on the use of benzodiazepines by older adults is warranted.

Contents

• REVIEWERS
• ACRONYMS AND ABBREVIATIONS
• EXECUTIVE SUMMARY
• 1. CONTEXT AND POLICY ISSUES
• 2. RESEARCH QUESTIONS
• 3. METHODS
  • 3.1 Literature search
  • 3.2 Article selection
• 4. SUMMARY OF FINDINGS
  • 4.1 Systematic reviews and meta-analyses
  • 4.2 Guidelines and Recommendations
  • 4.3 Limitations
• 5. CONCLUSIONS AND IMPLICATIONS FOR DECISION- OR POLICY-MAKING
• REFERENCES
• APPENDIX 1 LITERATURE SEARCH STRATEGY
• APPENDIX 2 ELIGIBILITY CRITERIA
• APPENDIX 3 SELECTION OF PUBLICATIONS
• APPENDIX 4 RISK OF FRACTURES IN PATIENTS TAKING PSYCHOTROPIC DRUGS (TAKKOUCHE ET AL.)
• APPENDIX 5 SUMMARY OF GUIDELINES ADDRESSING THE USE OF BENZODIAZEPINES IN THE ELDERLY

Health technology assessment agencies face the challenge of providing quality assessments of medical technologies in a timely manner to support decision-making. Ideally, all important deliberations would be supported by comprehensive health technology assessment reports, but the urgency of some decisions often requires a more immediate response.

The Health Technology Inquiry Service (HTIS) provides Canadian health care decision-makers with health technology assessment information, based on the best available evidence, in a quick and efficient manner. Inquiries related to the assessment of health care technologies (drugs, devices, diagnostic tests, and surgical procedures) are accepted by the service. Information provided by HTIS is tailored to meet the needs of decision-makers, taking into account the urgency, importance, and potential impact of the request.

Consultations with the requestor of this HTIS assessment indicated that a review of the literature would be beneficial. The research question and selection criteria were developed in consultation with the requestor. The literature search was carried out by an information specialist using a standardized search strategy. The review of evidence was conducted by one internal HTIS reviewer. The draft report was internally reviewed and externally peer-reviewed by two or more peer reviewers. All comments were reviewed internally to ensure that they were addressed appropriately.

CADTH is funded by Canadian federal, provincial, and territorial governments.

Suggested citation:

McIntosh B, Clark M, Spry C. Benzodiazepines in Older Adults: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines [Internet]. Ottawa: Canadian Agency for Drugs and Technologies in Health; 2011 (Rapid Response Report: Peer-Reviewed Summary with Critical Appraisal). [cited 2011-01-06]. Available from: http://www.cadth.ca/index.php/en/hta/reports-publications/search/publication/2773.

Production of this report is made possible by financial contributions from Health Canada and the governments of Alberta, British Columbia, Manitoba, New Brunswick, Newfoundland and Labrador, Northwest Territories, Nova Scotia, Nunavut, Prince Edward Island, Saskatchewan, and Yukon. The Canadian Agency for Drugs and Technologies in Health takes sole responsibility for the final form and content of this report. The views expressed herein do not necessarily represent the views of Health Canada, or any provincial or territorial government.

This document is prepared by the Health Technology Inquiry Service (HTIS), an information service of the Canadian Agency for Drugs and Technologies in Health (CADTH). The service is provided to those involved in planning and providing health care in Canada. HTIS responses are based on a comprehensive and systematic search of literature available to CADTH at the time of preparation. The intent is to provide a summary and critical appraisal of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. This response has been peer-reviewed by clinical experts. The information in this document is intended to help Canadian health care decision-makers make well-informed decisions and thereby improve the quality of health care services. HTIS responses should be considered along with other types of information and health care considerations. This report should not be used as a substitute for the application of clinical judgment in respect of the care of a particular patient or other professional judgment in any decision-making process, or as a substitute for professional medical advice. Readers are also cautioned that a lack of good-quality evidence does not necessarily mean a lack of effectiveness, particularly in the case of new and emerging health technologies for which little information can be found, but which may in the future prove to be effective. While CADTH has taken care in the preparation of this document to ensure that its contents are accurate, complete, and up to date as of the date of publication, CADTH does not make any guarantee to that effect. CADTH does not guarantee and is not responsible for the quality, currency, propriety, accuracy, or reasonableness of any statements, information, or conclusions contained in the source documentation. CADTH is not responsible for any errors or omissions or injury, loss, or damage arising from or relating to the use (or misuse) of any information, statements, or conclusions contained in or implied by the information in this document or in any of the source documentation.