No End in Sight: Benzodiazepine Use in Older Adults in the United States

Abstract

Background/Objectives To establish the rate of new and continuation benzodiazepine use among older adults seen by non-psychiatrist physicians, as well as identify patient subpopulations at risk for new and continuation benzodiazepine use. Design, Setting, Participants Cross-sectional analysis of the National Ambulatory Medical Care Survey (2007–2010) of all visits by adults to office-based non-psychiatrist physicians (n=98,818), then limited to those at which a benzodiazepine was prescribed (new or continuation). Measurements Percentage of benzodiazepine visits among all outpatient encounters by patient age and corresponding annual visit rate per 1,000 population. Analysis was then limited to adults ≥65; demographic, clinical, and visits characteristics were used to compare visits of benzodiazepine users with non-users and continuation users with new users. Results The proportion of benzodiazepine visits ranged from 3.2% (95% confidence interval [CI] 2.7–3.7%) among those 18–34 up to 6.6% (CI 5.8–7.6%) among adults ≥80 and the proportion of continuation visits increased with age, rising to 90.2% (CI 86.2–93.1%) among those ≥80. The population-based visit rate ranged from 61.7 (CI 50.7–72.7) per 1,000 persons among the youngest adults to 463.7 (CI 385.4–542.0) among those ≥80. Only 16.0% (CI 13.5–18.8%) of continuation users had any mental health diagnosis. Among all benzodiazepine users, less than 1% (CI .4–1.8%) were provided or referred to psychotherapy, while 10.0% (CI 7. 2–13.3%) were also prescribed an opioid. Conclusion In the US, few older adult benzodiazepine users receive a clinical mental health diagnosis and almost none are provided or referred to psychotherapy. Prescribing to older adults continues despite decades of evidence documenting safety concerns, effective alternative treatments, and effective methods for tapering even chronic users.

Concomitant use of benzodiazepines and opioids in community‐dwelling older people with or without Alzheimer's disease—A nationwide register‐based study in Finland

“…[1][2][3] The use of BZDRs in older people is problematic because they are associated with several risks, such as sedation, dependence, falls, and fractures. [1][2][3] The use of BZDRs in older people is problematic because they are associated with several risks, such as sedation, dependence, falls, and fractures.…”

“…Benzodiazepines and related drugs (BZDRs) are widely used in older patients, especially for the treatment of rather common symptoms such as anxiety and insomnia. [1][2][3] The use of BZDRs in older people is problematic because they are associated with several risks, such as sedation, dependence, falls, and fractures. 4 In general, BZDRs are approved for short-term use (less than 2-4 weeks) and not recommended for long-term use.…”

Epidemic Use of Benzodiazepines among Older Adults in Israel: Epidemiology and Leverage Points for Improvement

“…Benzodiazepines are commonly prescribed in many countries, including Israel. [1][2][3][4][5][6][7][8] This is problematic because these drugs can cause substantial harm. In older adults, benzodiazepine use increases the risk of falls, fracture, cognitive impairment, motor vehicle accidents, and other adverse outcomes.…”

“…9,12,13 Previous studies have documented the frequency of and risk factors for benzodiazepine and BDZRA use in different settings. [1][2][3][4][5][6][7][8]14 However, much less is known about potential leverage points that can be targeted to reduce high-risk use. The best opportunities may lie in curtailing the initiation of these drugs and preventing the transition from acute or intermittent use to chronic use, as it is very difficult to discontinue benzodiazepines in patients who have been using them chronically, even with comprehensive interventions.…”

Benzodiazepine and antipsychotic medication use in older adults

“…Nurses should advocate alternative strategies to off‐label prescription of benzodiazepine and antipsychotic medications in older adults to prevent central nervous system depression, aspiration pneumonia, falls and cognitive deficits (Shaw et al, ). Psychotherapy, stress management techniques and cognitive behavioural therapy (CBT) are all alternatives to consider besides prescribing benzodiazepines (Maust, Kales, Wiechers, Blow, & Olfson, ).…”