Taking sedatives to aid sleep may do the elderly more harm than good, researchers have concluded.
The team looked at the effects of sleeping pills
Up to a third of elderly people in the UK are prescribed sleeping pills because they are affected by insomnia.
Canadian researchers detail an analysis of 24 studies in a report in the British Medical Journal.
They conclude that the risk of side effects such as dizziness, loss of balance, falls, and disorientation outweighed the benefits of such drugs.
The studies, carried out between 1966 and 2003, covered 2,417 participants over 60.
People who had taken sedatives for five consecutive nights were compared with others taking dummy pills.
The studies covered a range of medications, including over-the-counter medications such as antihistamines, and prescription only drugs like benzodiazepine.
Effects such as dizziness or loss of balance were reported in 13 studies (1,016 participants).
Seven cases led to serious events - six falls and one car crash.
Benefits from taking sedatives, such as more sound uninterrupted sleep, ease of getting to sleep and greater total sleep time, were reported.
But, writing in the BMJ, the team from the Centre for Addiction and Mental Health in Toronto suggested older patients are more than twice as likely to experience an adverse event after taking sedatives as they are to gain a better quality of sleep.
The team, led by Dr Usoa Busto, said: "Although the improvements in sleep variables obtained from prescription sedative hypnotics are statistically significant, the effect size is small, and the clinical benefits may be modest at best."
They added: "The added risk of an adverse event may not justify these benefits, particularly in a high risk elderly population."
The researchers suggested older people with sleep problems should try non-drug therapies, such as cognitive behaviour therapy.
"Because fewer risks are associated with behavioural therapies, they may be a viable treatment alternative in a healthy elderly population," they said.
Dr Peter Passmore, a geriatrician at Queen's University, Belfast, said the findings of the study did not apply to people with anxiety, other psychiatric conditions, or illnesses which caused them severe pain, who would benefit from taking sedatives.
And he said others should ensure they really do need the drugs: "People are on sedatives for a variety of reasons; It's an issue of reviewing the need for medication.
"Non-medication methods of helping sleep are worth trying.
"Older people tend to have a nap in the afternoon, which can disrupt night-time sleep, and they may be drinking tea or chocolate at bedtime, which both contain caffeine and can act as a diuretic, which can both disrupt sleep."
Dr Lorna Layward, research manager at Help the Aged, said: "This research will prove vital, not just because as many as half of all older people suffer from irregular patterns of sleep, accounting for 40% of sleeping pill prescriptions, but - importantly - because there isn't enough evidence-based research carried out on older people in this area.
She added: "The research reinforces the need for regular reviews of medicines for older people to ensure that the benefits outweigh the risk rather than vice versa."