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Available evidence indicates that benzodiazepines are commonly used to treat various disorders including anxiety, insomnia, agitation, alcohol withdrawal, and seizures.

 of benzodiazepine use among older adults in the United States is approximately 8.7%

; but it has been noted that approximately 44% of the prescriptions for benzodiazepine among older adults are potentially inappropriate.

2019 American Geriatrics Society Beers Criteria

 identifies benzodiazepines as potentially inappropriate medications for use among older adults.

) Factors associated with long-term use of benzodiazepines include the following: female sex, a diagnosis of Alzheimer disease (AD), schizophrenia, bipolar disorder, depression, coronary artery disease, and asthma/chronic obstructive pulmonary disease.

 is known to be associated with poor outcomes.

 One study found that benzodiazepine use was associated with greater risk for hospitalizations, emergency department visits, outpatient visits, and higher health care costs.

 Another study found the overdose death rate increased due to benzodiazepine use from 0.58 to 3.07 per 100,000 adults between 1996 and 2013.

 Benzodiazepines use is also associated with an increased risk of falls among older adults.

 Additionally, the use of benzodiazepines is associated with a 60% to 80% increase in the risk of traffic accidents.

 The co-ingestion of benzodiazepines and alcohol is associated with a 7.7-fold increased risk for traffic accidents.

Now, there is also emerging evidence that the use of 

 may increase the risk for developing dementia among older adults.

 This review evaluates the evidence from the literature on the association between benzodiazepine use and the risk for developing dementia.

A review of the literature indicates that there is a total of 15 studies that have evaluated the association between benzodiazepine use and the development of dementia.

 Four of the 15 studies were published prior to 2010

 and 11 of the studies were published since 2010.

Although there are no randomized controlled trials (RCTs) looking at the association between benzodiazepine use and the risk for dementia, 6 prospective cohort studies,

 and 1 retrospective cohort study18 explore the relationship. Two studies had both a prospective cohort and a case control component.

 Three of the studies were conducted in France,

 and 1 each in Sweden,14 the United States,

Of the 15 studies, 8 showed a positive association between benzodiazepine use and the development of dementia.

 Of these 8 studies, 2 were prospective cohort studies,

 had a prospective cohort and a case control arm to the study.

Four studies found benzodiazepines were not associated with the development of dementia.

 The negative studies included 2 case control studies,

 and 1 study that had a prospective cohort and a case control arm.

 One study found that previously using benzodiazepines was associated with the development of dementia, but current use was not.

 The other study found that short-term use of benzodiazepines was associated with the development of dementia, but long-term use was not.

 Finally, 1 prospective cohort study found that the use of benzodiazepines had a protective effect against the development of dementia.

More than half of the studies (8 out of 15, 53%) identified in the literature search showed a positive association between benzodiazepine use and the development of dementia. It is unclear whether there is any significant difference between men and women. This is true with higher doses; when the duration of use is shorter; for current users; for shorter-acting drugs; and study design (eg, cohort studies). (see 

Despite the evident association between benzodiazepine use and the development of dementia, a causality cannot be established, as none of the identified studies were RCTs.

Three important reviews have evaluated the association between benzodiazepine use and the development of dementia.

 In the first review, the investigators evaluated 3 studies that found an increased risk of cognitive decline among those using benzodiazepine, and 2 studies that found a lower risk of cognitive decline in former or ever users of benzodiazepines, and 2 studies that found no association between the use of benzodiazepines and the development of dementia.

 In another review that evaluated 10 studies, the investigators found that 9 studies showed an increased risk of dementia among those who used of benzodiazepines.

 The investigators opined that the risk of dementia increases with cumulative doses of medication, longer treatment duration, and when long-acting agents are used. In the third review that evaluated data from 11 studies, the investigators 

 positive association between benzodiazepine use and the development of dementia from 9 studies.

 One study found a protective effect for benzodiazepine use, and 1 study found no effect for benzodiazepine use and the development of dementia.

Three recent meta-analyses evaluated the risk of developing dementia among individuals who use benzodiazepines.

, which included data from 6 studies, the investigators found the pooled adjusted risk ratios (aRRs) for the development of dementia was 1.49 for those who have used benzodiazepines, 1.55 for those who recently benzodiazepines, and 1.55 for those who have previously used benzodiazepines, when compared with never users of benzodiazepines.

 The researchers stated the risk for dementia increased by 22% for every additional 20 defined daily doses of the drug per year (aRR=1.22).

that included data from 10 studies found the odds for developing dementia was higher by 78% among users those who were using benzodiazepines when compared to those who were not (OR=1.78)

 The investigators found a higher association when the studies were from Asia (OR=2.40), and a moderate association when the studies were from North America and Europe (OR=1.49).

 that included data from 12 prospective and retrospective cohort studies and case-control studies found that benzodiazepines can be a risk factor for the development of dementia (OR=1.38).

 The investigators concluded that the current evidence lacks the power to differentiate between the risks for the development of AD versus vascular dementias (VD), the risks when using long-acting versus short-acting benzodiazepines, and the risks based on the duration and the doses of the drugs that are used.

 Carl Salzman, MD, provided a counterpoint to the question on whether benzodiazepines cause AD.

 Salzman stated that “there is little doubt that benzodiazepines like other sedative hypnotics may be associated with impaired cognition which is usually mild and dose-dependent.” He reported that the usual recommendations include only short half-life benzodiazepines at low doses and, if clinically possible, for brief periods of time. Salzman opined that future studies are needed regarding benzodiazepines’ and other medications’ possible associations with the development of late-life cognitive disorders. Until then, he advised that we must assume that the appropriate use of benzodiazepines will not lead to the development of AD. One caution with this editorial is that it cites a limited number of studies evaluating the association benzodiazepines and AD, and it is difficult to develop any definitive conclusions based on these studies.

The available evidence for the association between benzodiazepine use and the development of dementia should be evaluated based on the heterogeneity between the studies and limitations of each of these studies. These studies were conducted in different countries and had differing methodologies. In addition, many studies did not control for confounding variables including educational attainment, the presence of depression, anxiety, insomnia, and alcohol use. Also, 4 studies used the older DSM III-R criteria for the diagnosis of the dementia, causing concerns regarding the validity of the diagnosis. It is unclear whether the observed association between the use of benzodiazepines and the development of dementia is really a causal effect, or the result of unmeasured confounding variables, as none of these studies were RCTs.

 occurs when a pharmaceutical agent has been inadvertently prescribed for an early manifestation of a disease that has not yet been diagnostically detected. A prolonged lag phase between the first appearance of brain pathology associated with dementias, the development of clinical symptoms that may be risk factors for dementias including anxiety and depression, and the actual clinical diagnosis of dementia has led to investigators citing protopathic bias or “reverse causality” as the main area of controversy regarding the association between benzodiazepine use and the development of dementia.

 To prove a definitive association between benzodiazepine use and the development of dementia, the studies would have to be approximately 3 decades long given the prolonged life course of neurodegenerative disorders like dementias.

There are 3 possible mechanisms that have been postulated for the association between benzodiazepine use and the development of dementia.

 For one, benzodiazepines possibly decrease activity of β-amyloid precursor protein-cleaving enzyme 1 (BACE-1) and c-secretase activity, thus promoting β-amyloid accumulation in the brain. Secondly, astrocytes near the β-amyloid accumulation in the brain secreting γ-aminobutyric acid (GABA), thereby promoting the negative cognitive effects of benzodiazepines. Finally, benzodiazepines may reduce the cognitive reserves by lowering brain activation levels.

Available evidence indicates a positive association between the use of benzodiazepines and the development of dementia, although causality cannot be inferred from this data. Despite the lack of evidence proving causality, the association between benzodiazepine use and the 

 is a major cause for concern given the prevalence benzodiazepine use among older adults. The prescription of benzodiazepines to older adults must be carefully reviewed given the lack of data regarding their long-term efficacy and their significant adverse effects including the risk for developing dementia.

is the chairman of the department of psychiatry and behavioral sciences, Cleveland Clinic Akron General, Akron, OH.

is a psychologist in the Department of Psychiatry and Behavioral Sciences, Cleveland Clinic Akron General, Akron, OH

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript.

1. Lader M. Benzodiazepines revisited--will we ever learn? 

3. Dionne PA, Vasiliadis HM, Latimer E, Berbiche D, Preville M. Economic impact of inappropriate benzodiazepine prescribing and related drug interactions among elderly persons. 

4. By the 2019 American Geriatrics Society Beers Criteria® update expert panel. 

American Geriatrics Society 2019 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults

5. Taipale H, Koponen M, Tanskanen A, et al. Long-term use of benzodiazepines and related drugs among community-dwelling individuals with and without Alzheimer disease. 

6. Bachhuber MA, Hennessy S, Cunningham CO, Starrels JL. Increasing benzodiazepine prescriptions and overdose mortality in the United States, 1996-2013. 

7. Díaz-Gutiérrez MJ, Martínez-Cengotitabengoa M, Sáez de Adana E, et al. 

Relationship between the use of benzodiazepines and falls in older adults: a systematic review

8. Dassanayake T, Michie P, Carter G, Jones A. Effects of benzodiazepines, antidepressants and opioids on driving: a systematic review and meta-analysis of epidemiological and experimental evidence. 

9. Verdoux H, Lagnaoui R, Begaud B. Is benzodiazepine use a risk factor for cognitive decline and dementia? A literature review of epidemiological studies. 

Benzodiazepines and risk of Alzheimer disease

11. Bocti C, Roy-Desruisseaux J, Hudon C, Roberge P. Benzodiazepine and dementia: a time for reflection. 

12. Fastbom J, Forsell Y, Winblad B. Benzodiazepines may have protective effects against Alzheimer disease. 

13. Lagnaoui R, Bégaud B, Moore N, et al. Benzodiazepine use and risk of dementia: a nested case-control study. 

14. Lagnaoui R, Tournier M, Moride Y, et al. 

The risk of cognitive impairment in older community-dwelling women after benzodiazepine use

15. Wu CS, Wang SC, Chang IS, Lin KM. The association between dementia and long-term use of benzodiazepine in the elderly: nested case-control study using claims data.

16. Wu CS, Ting TT, Wang SC, et al. Effect of benzodiazepine discontinuation on dementia risk.

17. Gallacher J, Elwood P, Pickering J, et al. Benzodiazepine use and risk of dementia: evidence from the Caerphilly Prospective Study (CaPS). 

18. Chen PL, Lee WJ, Sun WZ, etal. Risk of dementia in patients with insomnia and long-term use of hypnotics: a population-based retrospective cohort study. 

19. Billioti de Gage S, Bégaud B, Bazin F, et al. Benzodiazepine use and risk of dementia: prospective population based study. 

20. Billioti de Gage S, Moride Y, Ducruet T, et al. Benzodiazepine use and risk of Alzheimer disease: case-control study. 

21. Imfeld P, Bodmer M, Jick SS, Meier CR. 

Benzodiazepine use and risk of developing alzheimer disease or vascular dementia: a case-control analysis

22. Shash D, Kurth T, Bertrand M, et al. Benzodiazepine, psychotropic medication, and dementia: a population-based cohort study.

23. Gray SL, Dublin S, Yu O, et al. Benzodiazepine use and risk of incident dementia or cognitive decline: prospective population based study. 

24. Biétry FA, Pfeil AM, Reich O, et al. Benzodiazepine use and risk of developing alzheimers disease: A case-control study based on Swiss claims data. 

25. Nafti M, Sirois C, Kröger E, et al. Is benzodiazepine use associated with the risk of dementia and cognitive impairment-not dementia in older persons? The Canadian study of health and aging. A

26. Osler M, Jørgensen MB. Associations of benzodiazepines, z-drugs, and other anxiolytics with subsequent dementia in patients with affective disorders: a nationwide cohort and nested case-control study. 

27. Verdoux H, Lagnaoui R, Begaud B. Is benzodiazepine use a risk factor for cognitive decline and dementia? A literature review of epidemiological studies. 

28. Billioti de Gage S, Pariente A, Bégaud B. Is there really a link between benzodiazepine use and the risk of dementia?

29. Pariente A, de Gage SB, Moore N, Bégaud B. 

The benzodiazepine-dementia disorders link: current state of knowledge

Association between benzodiazepine use and dementia: a meta-analysis

31. Islam MM, Iqbal U, Walther B, et al. 

Benzodiazepine use and risk of dementia in the elderly population: a systematic review and meta-analysis

32. Lucchetta RC, da Mata BPM, Mastroianni PC. 

Association between development of dementia and use of benzodiazepines: a systematic review and meta-analysis.

Do benzodiazepines cause alzheimer disease?

Nearly half of the prescriptions for benzodiazepine among older adults are potentially inappropriate, so how best to do no harm?

Benzodiazepine Use and the Risk of Dementia

The number of Americans over the age of 65 

 by over one-third during the past decade and is expected to rise, with important implications for planning and delivery of health care.

 The most problematic expression of population aging is the clinical condition of frailty, defined as a state of vulnerability to poor resolution of homeostasis following stress; it is a 

 of cumulative decline in multiple physiological systems over a lifespan.

 The cumulative decline erodes homeostatic reserve until minor stressor events trigger disproportionately large and negative changes in health status. Up to half of those aged 85 years and older are frail, and this is associated with increased risk of disability and other physical and mental health outcomes.

When depression, the leading cause of global disease burden,

 is also present in frail elderly patients, they tend to have higher mortality risk as they display lower physical activity levels, have a greater prevalence of fatigue and significant weight loss, have slower gait speeds, and have weaker 

 evaluated whether frailty burden predicts who will or will not respond to antidepressant medication.

. Do frail elderly adults with a depressive disorder respond differently than non-frail elderly adults with depression when standard antidepressant treatments are implemented?

. Outpatient placebo-controlled 8-week clinical trial followed by 10-months of open treatment.

. 34 men and 66 women aged 60 years or older who received a diagnosis of major depressive disorder (MDD) or persistent depressive disorder and managed as outpatients at the Clinic for Aging, Anxiety and Mood Disorders at 

. Participants were treated with antidepressant medications (escitalopram or duloxetine) in a placebo-controlled trial for 8 weeks, following which participants could continue open-label treatment for 10 months. During these 10 months they were treated as clinically indicated with both antidepressant switching and augmentation strategies. Baseline and follow-up assessments were completed pretreatment, at 8 weeks, and at 6 and 12 months. The diagnoses of depression subtypes were made based on DSM-5 clinical interview, with severity assessments based on the Hamilton Depression Rating Scale (HAM-D).

. The 100 participants in the study were all 60 years or older and had a baseline score of 16 or higher on the 24-item HAM-D. They were all assessed for frailty at baseline (3 or more deficits on gait speed, grip strength, activity level, fatigue, and weight loss) and categorized into frail (n = 49) and non-frail (n = 51). There were no intergroup differences between medical comorbidities, socioeconomic status, demographics, cognitive, or depressive variables. Participants did not have any severe medical illnesses, substance use disorders, or cognitive impairments.

. After 8 weeks of acute placebo-controlled treatment, frail adults (n = 49) showed an average HAM-D score that is 2.82 points higher than the non-frail adults (t = 2.12, df89, p = 0.037) and this difference persisted over the entire study follow-up period of 10 months. Additional analysis revealed that weak grip strength and low physical activity levels were each associated with worse response to antidepressants and lower response and remission rates over the course of the study, while slow gait speed, exhaustion, and significant weight loss were not. Patients who are frail also received more antidepressant medication trials.

This study suggests that frailty identifies a high-risk subgroup of elderly patients with depressive disorders characterized by lower antidepressant response despite several antidepressant trials, some with augmentation trials.

 assessed an interesting question: Do elderly patients with depressive disorders and comorbid frailty respond differently to antidepressants compared with non-frail elderly patients with MDD? The authors branched off a previous metanalysis6 that found no statistically valid difference in response or remission to antidepressants compared to placebo in elderly adults. They hypothesized that an extra complexity, frailty, would pose even more pronounced challenges.

 It might possibly tease out a sub-population of elderly patients that would respond differently.

 Indeed, the findings in this study support the pre-study hypothesis, as this predominantly female, elderly patient population have poor responses but also often require additional antidepressant trials and perhaps polypharmacy antidepressant augmentation.

Frailty in the context of late-life depression may indicate 

 are not sufficient, and that adjunctive interventions in the form of physical therapy and exercise, behavioral therapy, case management, and other assistance may be needed. For psychiatrists who encounter elderly patients with depression in clinical practice, it is important to comprehensively assess them beyond the standard of psychiatric diagnosis and symptom severity ratings. Physical characteristics such as activity level, strength, and mobility can provide insight into the clinical trajectories of such patients.

outlines an approach to assessment and management of depression in elderly patients. It includes a careful frailty assessment to better understand the optimal treatment course of action.

There are several limitations to this study:

• Only escitalopram and duloxetine were used in the initial placebo-controlled treatment phase. Although the open label portion included additional interventions (antidepressant switch or augmentation), it is unclear whether different antidepressants or classes of antidepressants may have had different outcomes.

• In assessing depressive symptomatology, the Hamilton Depression Rating Scale was used. Although it is the most commonly used scale for reporting symptoms in research, this is not specific, or extensively validated, for the geriatric population.

• The study seems to have included a greater proportion of women than men, which may have skewed the baseline starting characteristics and outcomes.

• Additionally, the population comprises mostly Caucasian participants, with 16 years of education on average across the spectrum. Generalization to other races and ethnic backgrounds and to those with less or more education is questionable.

• Exclusion criteria eliminated those with extensive medical illnesses and acute needs as well as those with substance use in the past 12 months. From the perspective of real-life clinical practice this seems unrealistic.

• The sample was limited to 1 site, which happens to be a geriatric specialist site. The generalization outside this system to other communities and treatment settings is unknown.

is assistant professor of psychiatry at Dartmouth’s Geisel School of Medicine and Director of Addiction Services at New Hampshire Hospital, Concord, NH. He is Addiction Section Editor for 

. The author reports no conflicts of interest concerning the subject matter of this article.

1. Population and Housing Unit Estimates. United States Census Bureau. Accessed January 13, 2021. 

https://www.census.gov/programs-surveys/popest.html

2. Clegg A, Young J, Iliffe S, et al. Frailty in elderly people. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4098658/

3. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. 

4. GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. 

5. Brown PJ, Ciarleglio A, Roose SP, et al. 

Frailty worsens antidepressant treatment outcomes in late life depression

6. Mallery L, MacLeod T, Allen M, et al. Systematic review and meta-analysis of second-generation antidepressants for the treatment of older adults with depression: questionable benefit and considerations for frailty. 

Research zeroes in on how frailty impacts depression treatment in elderly patients.

How Frailty in Older Adults With Depression Hinders Antidepressant Response

FROM THE GROUP FOR ADVANCEMENT OF PSYCHIATRY

As the United States population ages, safe and effective geriatric care is needed as never before. By 2030, 20% of the population will be aged 65 years or older according to current 

s, a dramatic increase from the rate of 13% reported in the 2010 census.

 It is estimated that 14% to 20% of older adults require treatment for mental health conditions and/or substance use disorders.

 The anticipated increase in the number of older adults will place unprecedented and unrealistic burdens on our health care system, which now 

 fewer than 1400 board-certified geriatric psychiatrists.

 The current population of specialists is insufficient to meet even our present needs, and too few physicians are presently enrolled in geriatric psychiatry and geriatric medicine fellowship training to meet anticipated future needs. Because of the widening gap between the number of experts and the magnitude of patient needs, clinicians who have not had specialty training in geriatrics or geriatric psychiatry will provide the majority of mental health care for older adults.

The necessity for more geriatric mental health specialists and the urgent need to establish competencies in geriatric care for all clinicians who care for older adults were identified as national priorities in reports issued by the Institute of Medicine in 2008 and 2012.

 These goals have yet to be achieved. The Liaison Committee on Medical Education, which 

 accreditation for American medical schools, requires the undergraduate medical curriculum to “address each phase of the human life cycle,” but there is no stipulation for specific content or competencies in aging, geriatric care or geriatric mental health.

 Similarly, there are no national geriatric competency standards for nursing students, physician assistant students, or other allied health care trainees. In the absence of national competency requirements, curricula and training in aging and in geriatric care vary widely across institutions and training programs.

Inadequate recognition and management of common geriatric mental health conditions has serious consequences. Delirium, too often undetected on medical and surgical inpatient units, disproportionately affects older adults, and contributes to avoidable suffering and death.

 Aggression and other behavioral disturbances of dementias (major neurocognitive disorders) contribute to caregiver burnout and premature institutionalization.

 Late-life depression, the most frequent antecedent of suicide in older adults, is associated with potentially treatable suffering, excess disability, increased health care costs, and higher mortality.

 in older adults, is associated with falls, confusion, and preventable hospitalizations.

 Notwithstanding educational campaigns such as “

” (an initiative by the American Board of Internal Medicine Foundation

), benzodiazepines continue to be overprescribed to older adults, despite the complications associated with their excessive and chronic use.

There are 2 important reports that can help advance medical student geriatric education:

• In 2007, the American Association of Medical Colleges and John A. Hartford Foundation Consensus Conference developed the Minimum Geriatric Competencies for Medical Students. These include 26 behaviorally focused competencies nested in 8 domains: medication management; cognitive and behavioral disorders; self-care capacity; falls, balance, gait disorders; health care planning and promotion; atypical presentation of disease; palliative care, and hospital care for elders (

 Within each of these domains are listed between 2 to 5 specific skills that medical students should master before graduating medical school to ensure safe care of elders. While a number of medical schools have incorporated these competencies as objectives in creating clinical rotations for their students, wider adoption and implementation remain critical.

 a broader set of Geriatric Mental Health Learning Objectives for medical students that expands the domain of cognitive and behavioral disorders and addresses the need for specific knowledge and reasoning skills that medical students should attain in 6 key areas of normal aging, mental health assessment, psychopharmacology, depression, dementia, and delirium.

The intent of both of these reports was to establish proficiencies that delineate core material that all students should learn by the time of graduation from medical school in order to provide competent and safe care to older patients encountered during and after residency training.

 requires establishing an infrastructure of geriatric experts within key health care training organizations to dynamically and continuously build a workforce of appropriately trained clinicians, schooled and skilled in the health needs and vulnerabilities of older adults. These 2 reports support the development of that workforce by providing a framework for the creation of national curricula in geriatrics for medical students and allied health professions. They represent the consensuses of experts, derived from an evidence-based understanding of the essential and specific health care needs of older patients.

While achievement of these minimal competencies will not eliminate the need for specialty training and geriatric specialists, adoption of basic standards will improve the recognition and clinical management of key health conditions in older adults that impact quality of life and health care costs. Needed are national education mandates from accreditation organizations and congressional support to require enhanced education of all clinicians who care for older adults.

Such attention to improving education and training standards couldn’t be more pressing or timelier. We have just witnessed a United States presidential election in which both candidates were septuagenarians and we will soon inaugurate the oldest individual ever to assume the presidency. We urge the new president and members of Congress to make national standards for education in geriatric care a priority of health care reform. On local and national levels, psychiatrists have a leadership role to play in implementing effective and actionable strategies for increased geriatric mental health education in medical school and allied healthcare curricula.

Building upon existing competency guidelines to create national curricula will prepare the eldercare workforce to handle the growing health care needs of our aging population. Given the urgency of rapidly changing demographics, training the requisite workforce to care for the mental health needs of older patients must become a national priority.

is clinical director, Division of Geriatric Psychiatry and Neuropsychiatry, and associate professor of Psychiatry and Behavioral Sciences, Johns Hopkins Medicine, Baltimore, MD.

holds the Swank Foundation Endowed Chair in Memory Care and Geriatrics, Christiana Care Health System, Wilmington, DE, and is professor of Psychiatry and Human Behavior, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.

is Dr Sakauye is Emeritus Professor of Psychiatry at the University of Tennessee Health Science Center in Memphis, TN.

is clinical assistant professor at Boston University School of Medicine, adjunct clinical assistant professor at Tufts University School of Medicine and lecturer, part-time, at Harvard Medical School, Boston, MA. 

is professor of Psychiatry and Health Policy and Director, Center for Biomedical Ethics and Society at Vanderbilt University, Nashville, TN. 

 is vice chair in the Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, and chair of the American Psychiatric Association Council on Geriatric Psychiatry.

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6. Witlox J, Eurelings LS, de Jonghe JF, et al. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. 

7. Hiyoshi-Taniguchi K, Becker CB, Kinoshita A.

 What Behavioral and Psychological Symptoms of Dementia Affect Caregiver Burnout?

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 Management of neuropsychiatric symptoms of dementia in clinical settings: recommendations from a multidisciplinary expert panel

9. Wei J, Hou R, Zhang X, et al. The association of late-life depression with all-cause and cardiovascular mortality among community-dwelling older adults: systematic review and meta-analysis. 

10. Bock JO, Hajek A, Weyerer S, et al. The impact of depressive symptoms on healthcare costs in late life: Longitudinal findings from the AgeMoodDe Study. 

Polypharmacy including falls risk-increasing medications and subsequent falls in community-dwelling middle-aged and older adults

12. Choosing Wisely. Promoting conversations between patients and clinicians. Accessed December 3, 2020. 

13. Maust DT, Kales HC, Wiechers IR, et al. No end in sight: Benzodiazepine use in older adults in the United States. 

14. Leipzig RM, Granville L, Simpson D, et al. Keeping Granny safe on July 1: A consensus on minimum geriatric competencies for graduating medical students. 

15. Lehmann SW, Brooks WB, Popeo D, et al. 

The authors make the case for national education mandates from accreditation organizations and congressional support to require enhanced education of all clinicians who care for older adults.

Geriatric Psychiatry

Benzodiazepine Use and the Risk of Dementia

How Frailty in Older Adults With Depression Hinders Antidepressant Response

Raising the Bar on Geriatric Mental Health Competency Training

Easy To Miss, Hard to Treat: Notes on Frontotemporal Dementia

5 Steps to Improve Outcomes in Substance Abuse in Older Patients

The Most Prevalent Psychiatric Disorder in Older Adults

14 Medical Conditions That Contribute to Insomnia

Caring for Patients With Neurocognitive Disorders During the Pandemic

Parkinson Disease Psychosis

Managing Behavioral and Psychological Symptoms of Dementia