Aging and liver disease affect glucuronidation less than oxidative metabolic pathways. And thus, lorazepam, oxazepam, benzodiazepines in the elderly and temazepam are preferentially used in elderly patients over other benzodiazepines as they are metabolized only by glucuronidation and have no active metabolites.
Elderly patients may also be intrinsically sensitive to benzodiazepines, suggesting that the enhanced response to these drugs that occurs with aging has pharmacodynamic as well as pharmacokinetic components.
Long-term benzodiazepine administration may accelerate cognitive decline, due to benzodiazepines in the elderly patients. Postoperative confusion is more common in elderly with long-term benzodiazepine users.
Hence, benzodiazepines should be used cautiously in the elderly in the most minimal doses and only if required.