Benzodiazepines in Older Adults: Alzheimer Risk, Memory, and Beers Criteria

Joseph F. Goldberg, MD, continues his conversation with Carl Salzman, MD, in this second installment of "Brain Trust: Conversations in Psychopharmacology," turning to benzodiazepine use specifically in older adults. The American Geriatrics Society’s Beers Criteria flags benzodiazepines as potentially inappropriate for patients 65 years and older, citing heightened sensitivity to sedative-hypnotic effects and elevated fall risk.¹ Observational studies have also raised questions about a possible link between benzodiazepine use and Alzheimer disease, though this association is increasingly attributed to protopathic bias rather than a causal effect.² Salzman revisits his own nursing home research on benzodiazepine discontinuation and memory, along with practical strategies for dosing, monitoring, and shared decision-making in geriatric patients. Salzman closed with the case for what he calls "mindful prescribing": matching benzodiazepine use to genuine clinical need rather than reflexive avoidance or reflexive prescribing.