Benzodiazepine Often Used in Older People Despite Risks

The analysis reveals worrisome patterns in the prescribing of benzodiazepines for older adults.

Benzodiazepines include the medications alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan). These drugs are widely prescribed to treat anxiety and sleep problems. But while effective, they have serious risks—especially when used over long periods. Long-term use can lead to dependence and withdrawal symptoms when discontinued. Benzodiazepines can impair cognition, mobility, and driving skills in older people, as well as increase the risk of falls. A recent study also found an association between benzodiazepine use in older people and increased risk of Alzheimer’s disease.

Practice guidelines now recommend psychotherapy approaches and antidepressants as the initial treatment for anxiety. For insomnia, guidelines recommend behavioral interventions as first treatment.

Despite the large number of benzodiazepine prescriptions in the United States — 85 million in 2007 — relatively little has been known about prescription patterns. Dr. Mark Olfson at the New York State Psychiatric Institute and Columbia University, Dr. Marissa King at Yale University, and Dr. Michael Schoenbaum at NIH’s National Institute of Mental Health (NIMH) thus examined rates of benzodiazepine use by sex and age.

The researchers examined prescription patterns from 2008 using data from a national prescription database (IMS LifeLink LRx Longitudinal Prescription database) and a national database on medical expenditures collected by the Agency for Healthcare Research and Quality. The study appeared online on December 17, 2014, in JAMA Psychiatry.

Among all adults ages 18 to 80 years, about 1 in 20 received a benzodiazepine prescription in 2008. This fraction rose substantially with age, from 2.6% among those 18 to 35, to 8.7% in those 65 to 80. Long-term use—for more than 120 days—also increased markedly with age. Of people 65 to 80 who used benzodiazepines, 31.4% received prescriptions for long-term use, vs. 14.7% of adults 18 to 35.

In all age groups, women were about twice as likely as men to receive benzodiazepines. Among women 65 to 80 years old, 1 in 10 was prescribed one of these medications, with almost a third of those receiving long-term prescriptions.

Most prescriptions for benzodiazepines were written by non-psychiatrists. Overall, about two-thirds of prescriptions for long-term use were written by non-psychiatrists; for adults 65 to 80, the figure was 9 out of 10.

“These medications can pose real risks, and there are often safer alternatives available,” Schoenbaum says. “Our findings strongly suggest that we need strategies to reduce benzodiazepine use, particularly for older women.”