Table 1 Studies and sub-studies included in the meta-analysis TABLE
Related Figures (2)
Ficure 1. Flowchart of the literature search process associated with confusion, daytime sedation, memory problems, falls, and motor vehicle accidents.*° Although benzodiazepines are indicated for a limited number of psychiatric disorders, they are the most commonly prescribed psychotropic drugs among elderly people by family physicians and general practitioners.° Elderly people are at increased risk for both short- and long-term adverse effects.’ Between 5% and 33% of elderly people in North America and the UK are prescribed benzodiazepines or benzodiazepine receptor agonists for sleep problems.*? Compared with healthy individuals, the safety of benzodiazepines in elderly people is less clear because of the impaired metabolic elimination and increased sensitivity of this population. A meta- analysis on the risks and benefits of sedatives for insomnia among elderly people reported that the risk of adverse events was higher with sedative treatment than with placebo." Most adverse events were reversible and not severe." Adverse effects on cognition can be mistaken for the effects of old age. Two reviewers independently searched MEDLINE, EMBASE, and the Cochrane Database of Systemic Reviews for English-language publications from 1950 to June 2010, using the keywords ‘benzodiazepines’, ‘elderly’ and ‘adverse effects’. Retrieved studies were screenedaccordingtotheinclusion criteria of: (1) mean age older than 65 years, (2) use of benzodiazepines for anxiety or insomnia, (3) randomised controlled trial design, and (4) adverse events in the treatment and placebo groups, including accidental injuries/ falls, confusion, dizziness, somnolence, headache, depression, hypertension, and hangover. In studies where 2 different benzodiazepines were compared to a placebo, or if there were =2 different doses of the benzodiazepine used, data from these sub-studies were entered as separate entities (FIGURE 1). were entered as separate entities (FIGURE 1). cognition can be mistaken for the effects of old age. Figure 2. Forest plot of odds ratio The sample sizes of the trial and control groups in all studies were comparable, hence minimising weighting bias, except for one study in which al participants acted as both controls and patients at different stages of the study, and the effects of zopiclone were compared with flunitrazepam for insomnia over a 4-week period.” In the first week, 102 participants were given a placebo. In the second week, they were randomly assigned to receive either zopiclone or flunitrazepam. In the last week, al participants received placebo again as a washout. The adverse events were recorded in the first and last weeks for placebo.
