ABSTRACT
During the last half of the previous century and into the first two decades of the new millennium, prescription sedative-hypnotics, a subclass of the psychodepressants, have been very widely used by older adults, primarily for the management of anxiety disorders and insomnia. They also have been widely mis-prescribed and routinely medically misused in nursing homes for the purpose of “crowd control.” Consequently, in the U.S., iatrogenic cases of prescription sedative-hypnotic dependence or use disorder are now highest among older adults. In order to provide health and social care professionals with a comprehensive understanding of the use of sedative-hypnotics by older adults, this chapter presents and discusses two major subclasses of the prescription sedative-hypnotics—benzodiazepines and z-drugs—in their own individual sections. The chapter begins with the benzodiazepines and concludes with the z-drugs. In each section, the chapter gives particular attention to their histories, pharmacology, toxicology, current trends in medical prescription, and illicit or licit patterns of use among older adults during the new millennium. The chapter concludes with a comprehensive overview of the assessment, diagnosis, and demonstrated effective treatment approaches—both pharmacotherapeutic and psychotherapeutic/counseling—of sedative-hypnotic dependence or use disorder specifically among older adults.
