Sitting and standing BP can be monitored, particularly when multiple antihypertensives are used, to check for orthostatic hypotension, which may increase risk of falls and fractures.Levodopa clearance is reduced in elderly patients, who are also more susceptible to the drug’s adverse effects, particularly orthostatic hypotension and confusion.Risk of upper GI bleeding increases when NSAIDs are given with NSAIDs can also increase BP; this effect may be unrecognized and lead to intensification of antihypertensive treatment (a prescribing cascade—see Drug-disease interactions).
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As described in see Table: Potentially Inappropriate Drugs in the Elderly (Based on the American Geriatrics Society 2012 Beers Criteria Update), short-, intermediate-, and long-acting benzodiazepines are associated with increased risk of cognitive impairment, delirium, falls, fractures, and motor vehicle crashes in the elderly and should be avoided for the treatment of insomnia.
Benzodiazepines may be appropriate for treatment of anxiety or panic attacks in the elderly.
Once the patient responds, the dose should be titrated down, if possible, to the lowest effective dose. Clinical trial data relating to dosing, efficacy, and safety of these drugs in the elderly are limited.
Antipsychotics can reduce paranoia but may worsen confusion (see also Schizophrenia : Conventional antipsychotics).
Nonpharmacologic measures, such as cognitive-behavioral therapy, and sleep hygiene (eg, avoiding caffeinated beverages, limiting daytime napping, modifying bedtime) should be tried first.