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Benzodiazepines in the Elderly: Falls, Memory, and How to Come Off Them After 65
Johnny Tabaie, Founder & CEO, Holistic Sanctuary·Medically reviewed by 
Dr. Jose A. Jimenez, MD, Medical Director·Published · Last medically reviewed A drug prescribed for a few weeks that stayed for twenty years. What the research shows about benzodiazepines after sixty-five, what the Beers Criteria and the deprescribing guidelines say, and how a supervised taper is done.
Read This Part First
Benzodiazepines in the elderly are the most common example in medicine of a drug that was prescribed for a few weeks and stayed for twenty years. The typical story is not misuse. It is a prescription for sleep or nerves written in someone’s fifties or sixties, renewed every month by a family doctor, and never revisited, until a fall, a hospital admission, or a worried son or daughter forces the question.
This page sets out what the research shows about benzodiazepines in the elderly: how common long-term use is, why a body over sixty-five handles these drugs differently, what the evidence says about falls, fractures, memory and dementia, what the Beers Criteria and the deprescribing guidelines recommend, what actually works when it is time to come off them, and how we do it here.
The non-negotiable first: do not stop a benzodiazepine abruptly at any age, and least of all after sixty-five. The FDA’s 2020 boxed warning states that abrupt discontinuation or rapid dose reduction can cause withdrawal reactions that are life-threatening, including seizures, and an older body has less reserve to survive them. Everything below is about a supervised, gradual taper. If you are thinking about suicide, call or text 988.
How Common It Is
Olfson, King and Schoenbaum’s 2015 study in JAMA Psychiatry, using national prescription data from 2008, found that 8.7 percent of Americans aged sixty-five to eighty filled a benzodiazepine prescription that year, more than three times the rate among adults under thirty-five, and that nearly a third of those older users were on the drug long term, meaning four months or more. The prescriptions were overwhelmingly written outside psychiatry; only about one in ten long-term users in that age group got the drug from a psychiatrist. The pattern Ashton described in Newcastle in the 1980s was, in other words, alive in the United States in 2008.
The picture of benzodiazepines in the elderly has improved, and it has not gone away. A 2026 analysis of the Medical Expenditure Panel Survey by Olfson and colleagues found that benzodiazepine use among adults fifty-six and older fell from 7.2 percent in 2018 to 4.7 percent in 2022, the largest decline of any age group. The same analysis found that about four in ten adults treated with benzodiazepines also received another central nervous system depressant in the same year, with the rate highest in the oldest cohorts.
That combination is the one the boxed warning was written about. Benzodiazepines in the elderly remain, by any measure, a common exposure in a population least able to tolerate it.
Why a Body Over 65 Handles Benzodiazepines Differently
Two things change with age. The first is sensitivity: the older brain responds more strongly to the same blood level of a benzodiazepine, so a dose that was mild at fifty is sedating at seventy-five. The second is clearance. The liver enzymes that break down most benzodiazepines slow with age, and the long-acting drugs, diazepam and chlordiazepoxide among them, have active metabolites that accumulate over days until the steady-state level is far higher than any single dose suggests. The American Geriatrics Society names both of these, increased sensitivity and decreased metabolism, as the reason benzodiazepines in the elderly are treated differently from benzodiazepines in the young.
Among benzodiazepines in the elderly, lorazepam, oxazepam and temazepam are the partial exception, because they are cleared by glucuronidation, a pathway that is relatively preserved with age, and they have no active metabolites. That is why a geriatrician who must use a benzodiazepine reaches for one of those three. It is not a reason to keep taking one for years. The sensitivity problem does not go away with a cleaner metabolism, and neither do the effects on balance and memory that follow.
Falls, Fractures and Driving
The best-known harm of benzodiazepines in the elderly is the fall. Woolcott and colleagues’ 2009 meta-analysis in the Archives of Internal Medicine, pooling studies of nine drug classes and falls in people over sixty, found that benzodiazepine use was associated with a fifty-seven percent increase in the odds of falling, an odds ratio of 1.57, alongside similar figures for other sedatives and for antidepressants. The mechanism is not mysterious: slowed reaction time, impaired coordination, muscle relaxation and daytime sedation, all of which the drug is designed to produce, in a person whose balance and bone density are already lower than they were.
A fall caused by benzodiazepines in the elderly is not a bruise. It is the hip fracture that starts the decline, the head injury that becomes a bleed, the six weeks in a chair that take the last of the muscle. The Beers Criteria list falls, fractures and motor vehicle crashes together as the reasons to avoid the class, and the driving point deserves its own sentence: a benzodiazepine taken at bedtime is still in the blood at the wheel the next morning, and in the older driver whose reaction time is already slower, the effect is measurable.
Memory, Confusion and the Dementia Question
Every benzodiazepine impairs the formation of new memories while it is active, at every age. In the elderly that effect is stronger, and it arrives on top of whatever age-related change is already present, which is why an older person on a nightly benzodiazepine is so often described by their family as “slipping” when what is slipping is the drug. The Beers Criteria name cognitive impairment and delirium among the harms of benzodiazepines in the elderly, and delirium in an older hospital patient, the acute confusion that so often follows surgery or infection, is a recognized consequence of both the drug and its abrupt withdrawal.
The dementia question about benzodiazepines in the elderly is harder and must be stated carefully. In 2014 Billioti de Gage and colleagues published a case-control study in the BMJ comparing 1,796 older people with Alzheimer’s disease against 7,184 matched controls in Quebec. Ever having used a benzodiazepine was associated with roughly fifty percent higher odds of an Alzheimer’s diagnosis; more than 180 prescribed daily doses, about six months of use, carried an odds ratio of 1.84, and long-acting drugs carried a higher ratio than short-acting ones.
The authors were explicit that a case-control study cannot prove causation and that early dementia may itself lead to benzodiazepine prescribing. It remains an association, and a strong reason not to stay on the drug by default.
The encouraging half of the story of benzodiazepines in the elderly is what happens after withdrawal. Barker and colleagues’ 2004 meta-analysis found that long-term benzodiazepine users improved on most measures of cognitive function in the months after stopping, though they had not fully caught up with controls at six months. Recovery is real, and it is slow, and it is one more reason to start the taper this year rather than next.
What the Beers Criteria Say
The American Geriatrics Society’s Beers Criteria are the standard list of medications that are potentially inappropriate in adults sixty-five and older, used across American hospitals, nursing homes and quality programs. The 2023 update lists benzodiazepines, all of them, as drugs to avoid in older adults, citing increased sensitivity and decreased metabolism of the long-acting agents and the risks of cognitive impairment, delirium, falls, fractures and motor vehicle crashes. It allows exceptions for seizure disorders, REM sleep behavior disorder, benzodiazepine withdrawal, alcohol withdrawal, severe generalized anxiety disorder, and anesthesia around procedures; it does not allow one for “she has been on it for years and is used to it.”
The criteria also address the Z-drugs, zolpidem, zaleplon and eszopiclone, which act on the same receptor, listing them as drugs to avoid in older adults for the same reasons. That matters because the most common mistake in managing benzodiazepines in the elderly is to swap the benzodiazepine for a Z-drug and call it deprescribing. It is not. It is the same pharmacology under a different brand.
Deprescribing: What Actually Works
The word geriatric medicine uses for stopping benzodiazepines in the elderly is deprescribing, and the evidence for it is better than most people expect. In 2014 Tannenbaum and colleagues published the EMPOWER trial in JAMA Internal Medicine: 303 community-dwelling adults over sixty-five on long-term benzodiazepines, recruited through thirty Montreal pharmacies, half of whom were simply mailed an eight-page booklet explaining the risks and offering a tapering plan to discuss with their doctor. At six months, twenty-seven percent of the booklet group had stopped completely against four and a half percent of controls. Information, offered to the patient directly, moved a needle that decades of prescriber education had not.
In 2018 the Canadian deprescribing guideline by Pottie and colleagues in Canadian Family Physician made a strong recommendation that adults sixty-five and older on a benzodiazepine or Z-drug for insomnia be offered a slow taper regardless of how long they had taken it. The trials it reviewed used gradual reductions, twenty-five percent every two weeks with a slower 12.5 percent step near the end, monitored every one to two weeks, and reported that withdrawal symptoms with tapering were mostly mild and brief and that cessation rates were far higher than with usual care.
The 2025 ASAM joint guideline is slower still, five to ten percent every two to four weeks, and slower again at low doses; a physician chooses the pace against the person, and after sixty-five the person usually needs the slower end.
Three rules hold for benzodiazepines in the elderly. The taper is gradual and supervised, never a stop. Nothing is added that acts on the same receptor, not a Z-drug, not alcohol. And the reasons the drug was started, sleep and anxiety most often, are addressed in the same months with methods that do not reproduce the problem: sleep habits, daylight, movement, and the unhurried attention that most eighty-year-olds have not been given by a doctor in a decade.
How We Do It Here After 65
I will describe how benzodiazepine dependence is treated at Holistic Sanctuary for guests over sixty-five and then say where the claim stops.
Programs here are built around twelve to sixteen weeks in residence, one guest to one clinical team, with a physician managing the taper and licensed nurses present twenty-four hours a day. For an older guest the pace is set at the slow end of the guidelines and adjusted day by day, because the physician is here and so are you, and the decision about substituting a longer-acting drug, which the Beers Criteria warn accumulates in older bodies, is made by that physician against your history rather than by a rule.
The medical screening we require of every guest before anything is administered, bloodwork, blood pressure, an EKG, a stress test and an echocardiogram reviewed by our medical director, is exactly the screening an older heart needs before a taper begins, and it is done here rather than assumed. What we do not do matters as much: there is no group therapy, no talk therapy in place of medicine, no Z-drug for sleep, no swapping one dependence-forming medication for another, and no psychobabble.
Benzodiazepines in the elderly are treated as what the research says they are, a physiological dependence in a body with less reserve, and fifteen years of doing this one guest at a time have taught us to go slower with every year of age.
The support around the taper is the Brain Repair IV protocol, a proprietary intravenous protocol our founder developed for exactly this work, running side by side with red light therapy, infrared sauna, NAD, daily massage, reiki and gentle morning yoga, the evidence for each of which is set out honestly, with its limits, on the timeline page. Every guest sleeps in a private oceanfront suite and eats organic food with no seed oils and no processed food, because an older body rebuilding its GABA system should not be asked to do it on a cafeteria diet.
Where the claim stops on benzodiazepines in the elderly: we do not claim to change anyone’s biology, we do not publish a success percentage, and we do not promise that a taper begun at seventy-two will be finished in twelve weeks. What we can say is that the program is designed around that window, that it is built on the Ashton method and the current guidelines, and that a slower, smoother, supervised taper in a place built for it is, in my experience, the version that holds.
For the method, read the Ashton Manual, explained; for the structure of treatment, how benzodiazepine treatment is built here; for the pillar, benzodiazepine withdrawal. Admission is by medical clearance.
Frequently Asked Questions
Why are benzodiazepines in the elderly considered dangerous?
Because the older brain is more sensitive to the same blood level, the long-acting drugs accumulate as metabolism slows, and the result is measurable harm: a 2009 meta-analysis found benzodiazepines raise the odds of a fall by about fifty-seven percent, and the 2023 Beers Criteria list cognitive impairment, delirium, falls, fractures and motor vehicle crashes as the reasons to avoid the class after sixty-five.
Do benzodiazepines cause dementia in older adults?
A 2014 BMJ case-control study found roughly fifty percent higher odds of an Alzheimer’s diagnosis in older people who had ever used a benzodiazepine, rising with cumulative dose. The authors said the study cannot prove causation and that early dementia may lead to prescribing. It is an association, not a proven cause, and a reason not to stay on the drug by default.
What do the Beers Criteria say about benzodiazepines?
The American Geriatrics Society’s 2023 Beers Criteria list all benzodiazepines, and the Z-drugs zolpidem, zaleplon and eszopiclone, as medications to avoid in adults sixty-five and older, with narrow exceptions such as seizure disorders, withdrawal management, severe generalized anxiety disorder and anesthesia around procedures.
Can an 80-year-old safely come off benzodiazepines?
Yes, with a slow supervised taper. The 2018 Canadian deprescribing guideline makes a strong recommendation to offer tapering to everyone over sixty-five on a benzodiazepine for insomnia regardless of duration, and the EMPOWER trial showed that older adults given clear information stopped at six times the rate of those who were not. Never stop abruptly.
How slowly should older adults taper?
For benzodiazepines in the elderly, the Canadian trials used about twenty-five percent every two weeks with smaller steps at the end; the 2025 ASAM guideline recommends five to ten percent every two to four weeks and slower at low doses. After sixty-five most people need the slower end, and the pace is always set by the person’s response, under a physician.
How does Holistic Sanctuary handle benzodiazepines in the elderly?
A physician-managed taper at the slow end of the guidelines, adjusted daily within a twelve-to-sixteen-week residential program, one guest to one clinical team, nursing around the clock, cardiac and blood screening before admission, no Z-drugs or substitute sedatives, no group or talk therapy, and the Brain Repair IV protocol alongside red light therapy, infrared sauna, NAD, massage, reiki and gentle yoga. No outcome is promised.
References
- American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023. pubmed.ncbi.nlm.nih.gov
- Olfson M, King M, Schoenbaum M. Benzodiazepine use in the United States. JAMA Psychiatry. 2015;72(2):136–142. jamanetwork.com
- Olfson M, McClellan C, Zuvekas SH, Blanco C. Trends in benzodiazepine prescribing to adults in the United States: results from the Medical Expenditure Panel Survey. J Clin Psychiatry. 2026;87(1). psychiatrist.com
- Woolcott JC, et al. Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med. 2009;169(21):1952–1960. pubmed.ncbi.nlm.nih.gov
- Billioti de Gage S, et al. Benzodiazepine use and risk of Alzheimer’s disease: case-control study. BMJ. 2014;349:g5205. pmc.ncbi.nlm.nih.gov
- Barker MJ, Greenwood KM, Jackson M, Crowe SF. Persistence of cognitive effects after withdrawal from long-term benzodiazepine use: a meta-analysis. Arch Clin Neuropsychol. 2004;19(3):437–454. pubmed.ncbi.nlm.nih.gov
- Tannenbaum C, Martin P, Tamblyn R, Benedetti A, Ahmed S. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial. JAMA Intern Med. 2014;174(6):890–898. pubmed.ncbi.nlm.nih.gov
- Pottie K, et al. Deprescribing benzodiazepine receptor agonists: evidence-based clinical practice guideline. Can Fam Physician. 2018;64(5):339–351. cfp.ca
- Brunner E, et al. Joint Clinical Practice Guideline on Benzodiazepine Tapering: Considerations When Risks Outweigh Benefits. J Gen Intern Med. 2025. link.springer.com
- U.S. Food and Drug Administration. FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class. 2020. fda.gov
- Ashton H. Benzodiazepines: How They Work and How to Withdraw (the Ashton Manual). 2002. benzo.org.uk
Medical disclaimer: this page is general information about benzodiazepines in older adults and is not medical advice or a taper schedule. Do not stop, reduce, or substitute a prescribed benzodiazepine without a physician; abrupt discontinuation can be life-threatening. Holistic Sanctuary does not diagnose, treat, or cure disease; individual results vary and no outcome is promised. In an emergency call 911. If you are thinking about suicide, call or text 988.
