Despite risks in elderly, benzodiazepine use increases with age

Dr Olfson

Despite known risks of confusion and falls associated with benzodiazepine use in elderly patients, a study published in JAMA Psychiatry, finds that prescription of benzodiazepines increases as people age. This research offers the first estimates of use patterns in the United States.

Mark Olfson, MD, MPH, professor of psychiatry at Columbia University Medical Center and researchers reviewed data from a large national prescription database (IMS LifeLink LRx Longitudinal Prescription database) to examine benzodiazepine prescription patterns from 2008. National estimates were determined by incorporating rates of the population with any prescription from the 2008 Medical Expenditure Panel Survey.  

Dr Olfson and colleagues found that approximately 1 in 20 US adults were treated with benzodiazepines in 2008. This rate increased with age so that approximately 1 in 12 older adults, aged 65 to 80 years, received benzodiazepines. Benzodiazepine use was almost twice as common among women as men. 

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“Of concern, almost one-third of the benzodiazepine use in older adults was for 4 months or longer,” Dr Olfson said. 

Benzodiazepines, which include Xanax, Valium and Ativan, are used to treat anxiety and sleep problems and are one the most commonly prescribed classes of medications in developed countries. Long-term use of these medications, a period of 4 months or more, carries significant risks.

“Managed care and hospital decision-makers should be aware that large numbers of older adults, especially women, are prescribed benzodiazepines and are therefore at increased risk of acute healthcare utilization related to falls and accidents including motor vehicle accidents,” Dr Olfson said. “These risks are related to the tendency of benzodiazepines to reduce motor coordination and increase fatigue and drowsiness. In evaluating the risk profile of covered populations, it is important to consider the proportion of older adults who are treated with benzodiazepines.”    

Another concerning pattern is that only around 10% of adults aged 65 to 80 who received long-term treatment with benzodiazepines received any of their benzodiazepine prescriptions from psychiatrists, physicians who specialize in the assessment and treatment of mental disorders.

“These new findings reveal worrisome patterns in use of benzodiazepines for older adults, especially for women,” he said. “The analysis suggests that benzodiazepine use by older Americans exceeds what research suggests is safe and that large numbers of older adults are put at unnecessary risks of falls and accidents. The findings will hopefully encourage healthcare professionals to teach older adults with anxiety or insomnia about other approaches to relieve stress and promote healthy sleep. We need to promote safer alternative treatments.”

The research was funded by contracts from the National Institutes of Health to Yale University and Columbia University, grant U19HSO2112, from the Agency for Healthcare Research and the New York State Psychiatric Institute.