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| |  Elderly On Long-Acting Anxiety, Insomnia Drugs Have More Car Crashes CHICAGO -- June 30, 1997 -- Elderly people taking a certain type of drug for anxiety or insomnia are at increased risk for motor vehicle crashes, according to an article this week’s issue of The Journal of the American Medical Association (JAMA). Brenda Hemmelgarn, M.N., Samy Suissa, Ph.D., and colleagues from McGill University and Royal Victoria Hospital, Montreal, Quebec, studied 224,734 drivers, aged 67 to 84 years, to determine if benzodiazepines are associated with car crashes in elderly drivers. The researchers found a 45 percent increased rate of motor vehicle crashes involving injuries for elderly patients during the first seven days of taking a long-acting form of benzodiazepine. After continuous use of the drug for up to one year, the increased risk was 26 percent. The increased risk was found only with long-acting benzodiazepines, not with short-acting benzodiazepines. Benzodiazepines are among the most frequently prescribed medications for the elderly. Side effects include drowsiness, sedation, confusion and impaired motor function, particularly among the elderly, according to information cited in the study. "Although evidence from randomized trials is not available, our findings, in combination with other recent studies of benzodiazepine use in the elderly, indicate a significant risk of injurious motor vehicle crash associated with long-half-life products,” the authors write. “The risk appears to be highest within the first seven days of initiating therapy and is reduced significantly but remains elevated with prolonged use." "In the present study we found that risk remained elevated for continuous use of up to one year, contrary to what has been previously speculated,” They add. “These results suggest that tolerance to the sedative and psychomotor effects of these long-half-life products may not develop with continued use, or, as has been proposed, tolerance may develop for some but not all of the psychomotor skills." Safety and Mobility of the Older Driver: A Research Challenge "The studies of benzodiazepines and crash involvement add to the already long list of reasons to avoid benzodiazepines in older patients -- particularly long-half-life drugs or long-term use.” writes Wayne A. Ray, Ph.D., from Vanderbilt University School of Medicine, Nashville, Tenn., in an accompanying editorial. “Even if short-acting benzodiazepines are less likely to increase the risk of injuries, other adverse effects suggest these agents be used very cautiously among elderly patients." "Yet, benzodiazepine use is but one of many factors that may impair driving and that are more common among older than younger drivers,” he added. “It seems unavoidable that growing numbers of functionally impaired drivers will trigger public concern with safety and perhaps even attempts to more tightly regulate driving among the elderly. Given the nearly complete reliance on driving for mobility in most of the United States, such restrictions could severely compromise older persons' independence." "Unfortunately, research on crash epidemiology in the elderly is in its infancy and the times are not (favorable) for funding major new research initiatives,” Ray concludes in the editorial. “Nevertheless, absent a reinvigorated research agenda for crashes in older drivers, we are unlikely to strike the delicate balance between safe driving and the mobility and independence of an aging population."
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