Overprescribing Concerns: The Continued Use of Benzodiazepines, Antibiotics, and Aspirin Among Older Adults

Despite evolving medical guidelines, studies indicate that many older adults continue to rely heavily on medications such as benzodiazepines, antibiotics, and aspirin, raising significant concerns over their health implications.

The medical community is increasingly scrutinizing the prescribing patterns of medications among older adults, revealing a gap between evolving clinical guidelines and actual prescribing practices. A recent analysis highlights that several medications commonly used by older patients may not only be less effective than previously believed but may also pose substantial health risks that outweigh their intended benefits.

As noted by Michael Steinman, a geriatrician at the University of California-San Francisco, “Medications are like barnacles; they’re easy to start, but they can be hard to stop.” This phenomenon can be attributed to several factors, including the time lag in disseminating new research to healthcare professionals and the established habits that clinicians and patients develop over time. Consequently, even when medical guidelines shift, actual medication use may not decline as expected.

The Drawbacks of Benzodiazepines

Benzodiazepines, which are commonly prescribed for anxiety and insomnia, have been under scrutiny for more than two decades. Mark Olfson, a psychiatrist and epidemiologist at Columbia University, emphasizes that while these medications provide quick relief, they carry significant risks, particularly for older adults. “They may impair balance, coordination, and cognition, which can lead to falls, fractures, and motor vehicle accidents,” he explained. Additionally, the concurrent use of benzodiazepines with opioids increases the risk of overdose.

The potential for dependence is another serious concern. Olfson pointed out that prolonged use can lead to withdrawal symptoms when discontinuing the medication. According to a study published in the Annals of Internal Medicine, the percentage of older adults filling prescriptions for benzodiazepines decreased from approximately 14% in 2015 to 11.5% in 2024. However, this decline has plateaued since 2020, possibly exacerbated by the COVID-19 pandemic. Alarmingly, the rate of benzodiazepine prescriptions among those aged 75 and older actually rose during this period, from 12% to around 13%. Moreover, one-third of users were found to have been on these medications for more than six months, significantly increasing the risk of dependence.

Overprescribing Antibiotics

Antibiotic use among older adults, particularly for the treatment of uncomplicated diverticulitis, has also raised red flags. Traditionally, antibiotics such as fluoroquinolones (Cipro, Levaquin) and amoxicillin-clavulanate (Augmentin) were routinely prescribed for this condition, based on the belief in their safety and effectiveness. Jesse Sutton, a pharmacist and researcher at the Minneapolis Veterans Affairs healthcare system, noted that this treatment approach was widely accepted: “The mindset was: When in doubt, use them.”

However, in 2015, the American Gastroenterological Association recommended against the routine use of antibiotics for uncomplicated diverticulitis, citing clinical trials that demonstrated no significant benefits regarding mortality, surgery necessity, or recurrence rates. Despite these recommendations, Sutton’s recent study involving 70,000 visits across 120 VA facilities revealed that antibiotic prescriptions for uncomplicated diverticulitis remained astonishingly high at 97%. This trend of overprescribing extends to other common conditions in older adults, including urinary tract infections and viral upper respiratory infections.

Sutton advises patients to engage their healthcare providers in discussions regarding the rationale behind antibiotic prescriptions, emphasizing the need for transparency in understanding potential risks. “I’d encourage patients to say, ‘Please explain the rationale for doing this,’” he noted.

When Aspirin Isn’t the Answer

Aspirin’s role in medication management for older adults presents a unique case. Though it is effective for secondary prevention in individuals with a history of cardiovascular events, its use for primary prevention has come under scrutiny. In 2019, the American College of Cardiology and the American Heart Association updated their guidelines, recommending against aspirin use for primary prevention in individuals aged 70 and older. The U.S. Preventive Services Task Force further cautioned against its use for primary prevention starting at age 60.

Timothy Anderson, an internist at the University of Pittsburgh, explained that while large clinical trials have shown minimal benefit from aspirin for primary prevention, the associated risks, particularly gastrointestinal bleeding, increase with age. A recent study published in JAMA revealed a noteworthy decline in aspirin use for primary prevention among older adults from 2011 to 2023. However, over one-third of individuals aged 70 and older still reported taking aspirin, often without proper medical guidance.

Anderson highlighted the importance of individualized care, stating, “Step 1 is a conversation with your primary care physician about aspirin: ‘Is this still right for me as I get older?’” He noted that while some high-risk older adults may benefit from continued aspirin use, for many, the risks generally exceed the benefits, particularly when more effective alternatives such as blood pressure medications and statins are available.

The persistence of these prescribing habits among older adults, despite evolving medical evidence, underscores the complexities involved in medication management within this demographic. As researchers and healthcare professionals continue to address these challenges, the dialogue surrounding appropriate medication use remains crucial for safeguarding the health and well-being of older patients.