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Despite Risks, Benzodiazepine Use Highest in Older People

NIH study examines prescribing patterns

The prescription use of benzodiazepines — a widely used class of sedative and anti-anxiety medications — increases steadily with age, despite the known risks for older people, according to a new analysis of benzodiazepine prescribing in the U.S.

            Given existing guidelines cautioning health care providers about benzodiazepine use among older adults, findings from the National Institutes of Health-funded study raise questions about why so many prescriptions — many for long-term use — are being written for this age group.

            The findings were published online December 18 in JAMA Psychiatry.

            The study found that among adults 18 to 80 years old, approximately 1 in 20 received a benzodiazepine prescription in 2008, the period covered by the study. But this fraction increased substantially with age, from 2.6% among those 18 to 35 years old to 8.7% among those 65 to 80 years old, the oldest group studied. Long-term use — a supply of the medication for more than 120 days — also increased markedly with age.

            Of people aged 65 to 80 years who used benzodiazepines, 31.4% received prescriptions for long-term use compared with 14.7% of users aged 18 to 35 years. In all age groups, women were approximately twice as likely as men to receive benzodiazepines. Among women 65 to 80 years of age, 1 in 10 was prescribed one of these medications, with almost one-third of those receiving long-term prescriptions.

            “These new data reveal worrisome patterns in the prescribing of benzodiazepines for older adults and for women in particular,” said Thomas Insel, MD, director of the National Institute of Mental Health (NIMH), which supported the study. “This analysis suggests that prescriptions for benzodiazepines in older Americans exceed what research suggests is appropriate and safe.”

            Benzodiazepines are among the most commonly prescribed medications in developed countries. They include alprazolam (Xanax, Pfizer), diazepam (Valium, Genentech), and lorazepam (Ativan, Pfizer). The most common use of benzodiazepines is to treat anxiety and sleep problems. While effective for both conditions, these medications have risks, especially when used for long periods. Long-term use can lead to dependence and withdrawal symptoms when discontinued. In older people, research has shown that benzodiazepines can impair cognition, mobility, and driving skills, and can increase the risk of falls.

            The authors used data from the national IMS LifeLink LRx Longitudinal Prescription database and from a national database on medical expenditures collected by the Agency for Healthcare Research and Quality to examine prescription patterns from 2008. Among their key findings:

  • The use of benzodiazepines increased steadily with age: 5.2% of adults 18 to 80 years old received one or more benzodiazepine prescriptions in 2008; 2.6% of those aged 18 to 35; 5.4% of those aged 36 to 50; 7.4% of those aged 51 to 64; and 8.4% of those aged 65 to 80.
  • Overall, approximately one quarter of prescriptions involve long-acting formulations of benzodiazepines.
  • Most prescriptions for benzodiazepines are written by non-psychiatrists. For adults 18 to 80 years old, approximately two-thirds of prescriptions for long-term use are written by non-psychiatrists; for adults aged 65 to 80, the figure is 9 out of 10.

            Benzodiazepines are effective in relieving anxiety and take effect more quickly than antidepressant medications often prescribed for anxiety. However, the prevalence of anxiety disorders declines with age. Practice guidelines recommend non-pharmacologic approaches and antidepressants over benzodiazepines as first-line treatment. Rates of insomnia increase with age, but practice guidelines recommend that health care providers consider behavioral interventions as first-line treatment over medications. Neither of these conditions explains the rates of prescribing benzodiazepines for older age groups, the authors say.

            Adding to concerns about the possible health consequences of benzodiazepine use, a recently reported study found an association between benzodiazepine use in older people and an increased risk of Alzheimer’s disease. The association was stronger with increasing length of use; the risk was nearly doubled for those using benzodiazepines for more than 180 days.

            Source: NIH; December 17, 2014.


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