Medical inertia leaves millions of older Americans taking potentially inappropriate medications, according to recent studies highlighting a persistent gap between updated clinical guidelines and everyday prescribing habits. Medications are easy to start but notoriously difficult to stop, according to Dr. Michael Steinman, a geriatrician at the University of California, San Francisco, and co-director of the U.S. Deprescribing Research Network. Clinicians face a vast volume of information, and established prescribing patterns quickly become ingrained habits that are challenging to break.
Benzodiazepine Use Rises Among the Oldest Adults
Prescribing trends for benzodiazepines show mixed progress among older demographics, according to an analysis published in the Annals of Internal Medicine by Dr. Mark Olfson, a psychiatrist and epidemiologist at Columbia University, and his research team. Overall use among people over 65 dropped from 14 percent down to 11.5 percent between 2015 and 2024.
However, that decline stalled following the Covid-19 pandemic. Among adults over 75, use actually increased from 12 percent in 2020 to about 13 percent four years later, while dispensing through long-term care facility pharmacies more than doubled. About a third of users took the drugs for longer than six months, raising the risk of dependence.
Benzodiazepines like Valium, Xanax, Ativan, and related Z drugs such as Ambien and Lunesta can impair balance, coordination, and cognition, leading to falls, fractures, and motor vehicle accidents, according to Dr. Olfson. Dr. Olfson cautions that patients must not stop taking benzodiazepines suddenly on their own due to withdrawal risks, noting that supervised tapering with a medical professional takes many weeks.
Did You Know?
Benzodiazepines and related Z drugs offer prompt relief for insomnia and anxiety, but prolonged use builds physiological dependence and complicates discontinuation.
Antibiotic Overuse Persists for Diverticulitis
Antibiotic prescriptions for uncomplicated diverticulitis remain near universal despite medical guidelines advising against them, according to a study of 70,000 visits across 120 Veterans Affairs facilities led by pharmacist and researcher Jesse Sutton. Published in the Annals of Internal Medicine, the findings showed that 97 percent of visits still resulted in antibiotic prescriptions, matching previous decade-long trends.
The American Gastroenterological Association recommended against routinely prescribing antibiotics for uncomplicated diverticulitis in 2015, noting that clinical trials showed little to no effect on mortality, surgery needs, complications, or recurrences. Yet the mindset of using antibiotics as safe, foundational drugs remains deeply rooted, according to Dr. Sutton.
Dr. Sutton encourages patients to ask physicians for the rationale behind prescribing antibiotics for conditions like uncomplicated diverticulitis, urinary tract infections without troublesome symptoms, and viral upper respiratory infections.
Aspirin Guidelines Shift Away From Primary Prevention
Daily low-dose aspirin helps prevent secondary cardiac events for patients who have already experienced a heart attack, stroke, or intervention like a stent or bypass surgery. But recommendations changed significantly for primary prevention in individuals without a prior cardiac history, according to Dr. Timothy Anderson, an internist at the University of Pittsburgh and director of its Prescribing Wisely Lab.
The American College of Cardiology and the American Heart Association recommended against aspirin for primary prevention in adults aged 70 and older in 2019, while the U.S. Preventive Services Task Force extended that caution to individuals starting at age 60. Large clinical trials demonstrated scant benefit for primary prevention alongside significant bleeding risks, particularly gastrointestinal bleeding and more serious bleeding in the brain.
A study co-authored by Dr. Anderson in JAMA showed that primary prevention aspirin use dropped substantially from 2011 to 2023 based on the National Health and Nutrition Examination Survey. Still, more than a third of adults 70 and older continued taking it. Dr. Anderson advises patients to consult primary care physicians before changing routines, noting that discontinuing aspirin can sometimes increase cardiovascular risk, and that blood pressure medications and statins offer better primary prevention strategies.
Frequently Asked Questions
What is the Beers Criteria?
Published by the American Geriatrics Society, the Beers Criteria is an influential list of potentially inappropriate medications that should generally be avoided or prescribed more selectively for older adult patients.
Why is it difficult for older adults to stop taking certain medications?
Medications can create physical dependence or become part of ingrained clinical and personal habits over many years, making supervised tapering and alternative approaches necessary.
Are all uses of daily aspirin discouraged for older adults?
No. Daily low-dose aspirin remains recommended for secondary prevention in patients who have already suffered a heart attack, stroke, or undergone cardiac procedures like bypass surgery.
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