An 82-year-old client receives a new prescription for flurazepam at bedtime and reports recent falls. Which action should the nurse take?
1Teach the client to take the medication after a nighttime awakening to limit daytime sedation.
2Recommend an alcoholic drink with the dose so a lower sedative effect is needed.
3Clarify the prescription because prolonged sedation can increase cognitive impairment and fall risk.✓ Correct answer
4Advise the client to take an extra dose if sleep does not begin within 30 minutes.
Explanation
Flurazepam is a long-acting benzodiazepine with an active metabolite that can accumulate and cause next-day impairment. Older adults have increased sensitivity to benzodiazepines and greater risk of cognitive impairment, delirium, ataxia, falls, and fractures. A new prescription in an 82-year-old with recent falls should be clarified and safer options assessed. Alcohol, middle-of-the-night dosing, and extra doses increase harm.
Clinical reasoning Flurazepam's prolonged active metabolite can extend sedation beyond the intended sleep period. Age-related pharmacodynamic sensitivity adds to gait and cognitive risk.
Decision rule Clarify a long-acting benzodiazepine order for an older adult with falls and request an individualized, lower-risk insomnia plan.
Scenario A 78-year-old female with new-onset insomnia and mild anxiety was prescribed diazepam 5 mg PO HS at the outpatient clinic. She lives alone, uses the bathroom multiple times each night, and has no walker. Her most recent fall risk score is moderate-to-high.
Long-acting benzodiazepine — A sedative with prolonged parent-drug or metabolite effects that can cause residual daytime psychomotor impairment.
Beers Criteria — A geriatric prescribing framework that identifies benzodiazepines as potentially inappropriate for many older adults because of cognitive and fall-related harms.
Fall risk — The probability of an unintentional fall, increased by medications causing sedation, orthostasis, or motor impairment; benzodiazepines significantly elevate fall risk in older adults.