Anxiety and
insomnia are prevalent conditions in the elderly, and
anxiolytics and
hypnotic drugs are commonly used. Pharmacokinetic variables--absorption, distribution, metabolism and elimination--are all altered to a greater or lesser extent. As a general rule, the elderly are more sensitive to
psychotropic drug actions than younger patients. This is particularly so in the over 80s. The elderly tend to suffer from physical conditions which may cause
insomnia and anxiety, and medication for those physical complaints may interact with psychotropic medication. In the treatment of
insomnia, short- or intermediate-acting
benzodiazepines are preferable to long-acting compounds which tend to accumulate and produce
confusional states and
ataxia. Similarly, the benefit/risk ratio for
anxiolytics is least in the elderly. Compounds of intermediate half-life and no active metabolites, such as
oxazepam, are preferable. Anxiety syndromes occurring in other contexts, e.g.
dementia may be better treated with low doses of
antipsychotic drugs.