Hypnotics are taken by a fifth of adults at home, and by half those in hospital for more than 17 days. Such prescription may be inappropriate in the elderly since their insomnia frequently results from conditions such as depression, boredom and loneliness. Furthermore the elderly are more susceptible to adverse drug reactions due to decreased efficiency in eliminating drugs from the body and increased target organ response. They are also less able to compensate for unwanted effects, which may last up to 36 hours after a single dose. Despite this, there appears little attempt to reduce dosage in old patients or to select hypnotics less likely to produce side effects. We would suggest that these drugs should be prescribed with caution in the elderly, and only after a full history and examination of the patient. The drug, dosage and length of treatment should then be selected individually.
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