Many Older Adults Prescribed Benzodiazepines Continue Use Long-term

September 19, 2018

One quarter of older adults prescribed benzodiazepines may go on to long-term use, warns a new study published online in JAMA Internal Medicine.

Researchers looked at 576 community-dwelling older adults who received their first benzodiazepine prescription between 2008 and 2016. The average age of patients receiving their initial benzodiazepine prescription was 78, the study found—despite national guidelines that largely recommend avoiding benzodiazepines in adults older than 65.

Of the 576 older adults with an initial benzodiazepine prescription, 152 still had a prescription a year later, putting them at increased risk of car crashes, falls, and other side effects. The study included only older adults whose benzodiazepines were prescribed by clinicians other than psychiatrists. The majority of older adults, according to researchers, receive benzodiazepine prescriptions from primary care providers.

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“This shows that we need to help providers start with the end in mind when prescribing a benzodiazepine, by beginning with a short-duration prescription, and engage patients in discussions of when to re-evaluate their symptoms and begin tapering the patient off,” said study lead author Lauren Gerlach, DO, a geriatric psychiatrist at the University of Michigan in Ann Arbor.

White patients were 4 times as likely to use benzodiazepines long-term, the study found. Older adults whose first prescription was for a large quantity were also at increased risk for long-term use. In fact, the risk of long-term use nearly doubled for every 10 additional days benzodiazepines were prescribed.

“This study provides strong evidence that the expectations set out by a provider when they first write a new prescription carry forward over time,” said senior author David Oslin, MD, of the University of Pennsylvania and the Corporal Michael J. Crescenz VA Medical Center in Philadelphia. “When a physician writes for 30 days of a benzodiazepine, the message to the patient is to take the medication daily and for a long time.”

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The study also found that older adults who used benzodiazepines long-term were no more likely have a diagnosis for anxiety. They were, however, more likely to have sleep problems. Although sometimes indicated long-term for anxiety, benzodiazepines are not recommended for long-term use as sleep aids and may worsen sleep with long-term use.

“Since mental health providers see only a very small minority of older adults who have mental health issues, we need to support primary care providers better as they manage these patients’ care,” Dr. Gerlach said.

—Jolynn Tumolo

References

Gerlach LB, Maust DT, Leong SH, Mavandadi S, Oslin DW. Factors associated with long-term benzodiazepine use among older adults. JAMA Internal Medicine. 2018 September 10;[Epub ahead of print].

Gavin K. 1 in 4 older patients stay on risky sedative too long [press release]. Ann Arbor, Michigan: Michigan Medicine; September 10, 2018.