Progress in reducing benzodiazepine prescriptions for older Americans stalled following the onset of the COVID-19 pandemic, ending a years-long downward trend. According to a study published in the Annals of Internal Medicine by researchers at the Columbia University Mailman School of Public Health and Columbia University Irving Medical Center, prescribing rates increased among adults aged 75 and older and those receiving medications through long-term care pharmacies after 2020.
Why did benzodiazepine prescribing trends shift after 2020?
While benzodiazepine use had been steadily declining prior to 2020, that momentum vanished during the pandemic. Dr. Mark Olfson, a professor of Epidemiology at the Columbia University Mailman School of Public Health, stated that the pandemic likely disrupted medication safety progress. Researchers identified several potential drivers for this reversal, including increased social isolation, staffing shortages within long-term care facilities, and reduced access to behavioral therapies.
The study, which analyzed IQVIA Longitudinal Prescription Claims data from 2015 through 2024, covered nearly 25 million adults aged 65 and older. The data represents more than 90 percent of retail pharmacy prescriptions and up to 80 percent of long-term care dispensing. The findings indicate that patients often turned to these medications as a greater reliance on medications emerged during the public health crisis.
Benzodiazepines are typically used for anxiety and insomnia, but medical guidelines generally recommend only limited use in older adults due to the increased risk of cognitive impairment, falls, and motor vehicle crashes.
Who is at the highest risk for medication-related complications?
Older adults, particularly those aged 75 and older, remain a priority population regarding benzodiazepine use. According to the research, individuals in long-term care are particularly vulnerable due to factors like frailty, the presence of multiple chronic conditions, and prolonged medication use.
The study highlights a demographic consistency: approximately two-thirds of the patients receiving these prescriptions were women. Because these patients are prone to adverse events, the authors argue that consistent, structured medication reviews are essential to ensure safety. Without these reviews, the risk of serious side effects—ranging from confusion to physical injury—remains significantly higher for this cohort.
How can healthcare providers reduce unnecessary benzodiazepine use?
To restart the progress seen before 2020, the study authors recommend a multi-pronged approach to medication management. Dr. Olfson emphasized that regular medication reviews are vital to identify patients who may no longer need these drugs. Furthermore, expanding access to non-drug therapies could serve as a safer alternative for managing anxiety and sleep issues in older populations.
Quality improvement programs within long-term care facilities are also being identified as a priority. By integrating these safety initiatives, providers may be able to sustain the reductions in potentially inappropriate prescribing that were observed in the years leading up to the pandemic.
Frequently Asked Questions
- Why are benzodiazepines considered risky for older adults?
They increase the likelihood of falls, cognitive impairment, and serious adverse events. - What data was used to reach these findings?
Researchers analyzed IQVIA Longitudinal Prescription Claims, accounting for over 90 percent of U.S. retail pharmacy prescriptions and roughly 75 to 80 percent of long-term care pharmacy dispensing. - Did prescribing levels return to pre-2015 rates?
No. While the downward trend stalled, prescribing remained below 2015 levels throughout the study period.
If you or a loved one are taking benzodiazepines, schedule a “brown bag” review with your primary care provider. Bring all current medications to the appointment to discuss whether they are still necessary or if safer alternatives are available.
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