Designed and created by Guideline Central in participation with the Canadian Coalition for Seniors’ Mental Health
Benzodiazepine Receptor Agonist Use Disorder Among Older Adults
Patient Guideline Summary
Publication Date: January 1, 2020
Last Updated: November 30, 2023
Objective
Objective
This patient summary means to discuss key recommendations from the Canadian Coalition for Seniors Mental Health (CCSMH) for benzodiazepine receptor agonist use disorder among older adults. It is limited to adults 18 years of age and older and should not be used as a reference for children.
Overview
Overview
- Benzodiazepine Use Disorder describes excess intake of sedative-hypnotic medicines like Valium, Librium, and Edluar leading to adverse consequences.
- We will use the abbreviation BZRA throughout this summary to refer to these drugs.
- The Diagnostic and Statistical Manual of Mental Disorders (DSM–5) lists 11 criteria relevant to the diagnosis of Benzodiazepine Use Disorder. The more criteria that are met, the more serious the condition.
- Symptoms include cognitive impairment, delirium, falls, fractures, hospitalizations, and motor vehicle crashes.
- This patient summary focuses on managing and reducing Benzodiazepine Use Disorder in the elderly.
Diagnosis
Diagnosis
- Diagnosis is based on the number of DSM-5 criteria that are met.
- The risk of abuse should be assessed before prescribing BZRAs, and patients should be advised of the risks and benefits.
Treatment
Treatment
- BZRAs in the elderly generally cause more problems than benefits by decreasing mental function and coordination, especially when used for long periods of time.
- Cognitive behavior therapies (CBTs) are safer and often more effective for insomnia, anxiety and symptoms of dementia.
- Therefore, other treatment options, a formal risk assessment for overuse and other adverse effects and informed consent should precede the use of BZRAs. Informed consent should include a planned and monitored duration of less than 4 weeks.
- Informed consent should include:
- discussion and education on the risks
- encouragement to limit dosage and duration of use
- a plan to monitor treatment
- a plan to end treatment that may require tapering the dose.
- Benzodiazepine Withdrawal: For patients dependent on BZRAs, withdrawal management requires:
- careful monitoring of symptoms to identify and quantitate withdrawal, preferably with a standardized questionnaire
- conversion of prescribed agents and alcohol to a single, long-lasting BZRA
- consideration of behavioral interventions
- referral to a specialty facility for augmented treatment when current treatment is failing.
Abbreviations
- BZRAs: Benzodiazepine Receptors Agonists
- CBTs: Cognitive Behavior Therapies
- CCSMH: Canadian Coalition For Seniors Mental Health
- DSM–5: Diagnostic And Statistical Manual Of Mental Disorders
Source Citation
Conn DK, Hogan DB, Amdam L, Cassidy KL, Cordell P, Frank C, Gardner D, Goldhar M, Ho JM, Kitamura C, Vasil N. Canadian Guidelines on Benzodiazepine Receptor Agonist Use Disorder Among Older Adults Title. Can Geriatr J. 2020 Mar 30;23(1):116-122. doi: 10.5770/cgj.23.419. PMID: 32226570; PMCID: PMC7067147.
Disclaimer
The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.