Progress, but Far from Perfection, on Avoiding Risky Sedatives in Older Adults

By Jane Farrell

Although it’s widely known that the medications known as benzodiazepines present particular risks for people over 65, a sizable percentage of adults in that group still have a prescription for one, according to new research from three countries that have made a special effort to reduce their use.

These medicines help many people sleep, or feel calmer or less anxious. But in older people, they also double the risk of car crashes, falls and broken hips. (Among the drugs in the benzodiazepine class are Xanax, Valium, Librium, Klonopin and Ativan.)

Currently, about seven percent of older veterans in the United States have a benzodiazepine prescription, and the numbers are even higher in Canada and Australia, according to the study published in the Journal of the American Geriatrics Society.

There’s been a steady decline in all such prescriptions since new guidelines came out, the research shows. And the number of older adults starting on the drugs for the first time has dropped even faster.

But despite these reductions, the researchers say that the continued use of the drugs shows much more needs to be done to alert providers, and patients and families, to their hazards and the need to find alternative treatments.

“This downward trend is definitely encouraging, in particular the trend in the new starts for these medications, because the easiest solution is to not start people on them at all,” says Donovan Maust, M.D., M.S., an assistant professor of geriatric psychiatry at the University of Michigan Medical School who worked on the study and has studied the risks of psychoactive drugs on older adults.

He notes that research shows that newer antidepressant medications, and non-drug psychotherapy approaches, have been shown to help ease many of the symptoms that often prompt doctors to prescribe benzodiazepines – without the risks. Also, research has shown that patients who take a benzodiazepine to calm the effects of acute stress are likelier to develop post-traumatic stress disorder.

An international group of authors, including Maust and his colleagues, looked at data from older adults treated in three different healthcare systems between 2010 and 2016: the U.S. Veterans Affairs healthcare system; Canada’s most populous province, Ontario; and Australia.

In all, the percentage of U.S. veterans over age 65 prescribed a benzodiazepine dropped from 9.2 percent in 2010 to 7.3 percent in 2016, and the percentage newly started on the drugs for the first time dropped from 2.6 percent to 1.7 percent over the same time period.

Maust notes that the veteran population likely has even lower benzodiazepine use than the general U.S. population because of ongoing VA efforts to discourage their use.

Ontario started with much higher prevalence: 18.2 percent of all older adults had a current prescription in 2010, declining to 13.4 percent by 2016. The province also made strides in reducing the percentage who started a prescription each year, from 6 percent to 4.4 percent.

Australia started off with the largest proportion of its over-65 population having a benzodiazepine prescription, at 20.2 percent in 2010. By 2016, that had declined to 16.8 percent. But the number of first-time prescriptions didn’t go down much – from 7 percent to 6.7 percent.