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Are Anti-Anxiety Drugs Safe for Older People?

Although older people are sometimes reluctant to divulge it, many of them experience anxiety. And when an older person is diagnosed with this condition, the best way to treat them is not always clear. In 2004, a study published in the Archives of Internal Medicine found that a popular class of anti-anxiety medications, benzodiazepines, increased the risk of hip fractures, and that the risk was highest in the first two weeks of taking the drug.

Benzodiazepines, which include drugs such as Valium (diazepam) and Xanax (alprazolam), can lead to falls because they can cause drowsiness and affect balance. Hip fractures are of particular concern to doctors and patients because they are known to profoundly affect quality of life. Only one-third of people who break their hip recover to their pre-fracture level of independence, and about 24 percent of people over age 50 die within a year.

Part of the confusion regarding treatment derives from previously research. Some studies have suggested that benzodiazepines contributed to an increase risk of hip fractures, while others did not uncover such as link. And still other studies demonstrated an increased risk only with the longer acting benzodiazepines, which are more slowly released in the body.

"Because elderly people’s aged systems excrete drugs more slowly, the drugs can accumulate in elderly people, so longer acting drugs have been particularly discouraged," says study author Dr. Anita K. Wagner, an instructor in the department of ambulatory care and prevention at Harvard Medical School.

In this study, Wagner and her colleagues analyzed 42 months of health insurance claims for more than 125,000 people enrolled in the New Jersey Medicaid program and categorized people as to whether they were taking a long- or short-acting drug. After taking into consideration other possible causes of a hip fracture, such as diagnoses of epilepsy or dementia, the researchers concluded that both types of benzodiazepines increased risk of hip fractures.

While there was no difference between benzodiazepine types, the researchers uncovered some difference in risk based on the length of time someone had been taking the drug. Risk was highest in the first week, then diminished in two weeks and was further reduced after a month.

"The reduced risk later on is most likely related to the fact that people get used to the sedative side effects and the impact on balance," Wagner explains. To try to prevent falls, the study authors recommend that the older person be looked after more carefully during the first couple of weeks on a benzodiazepine.

"When patients and doctors evaluate the risks and benefits of benzodiazepines, they should be particularly alert to increased sedation and the potential risk of fracture during the time when someone is starting a benzodiazepine, nor should they assume a shorting acting drug is safer," Wagner says.