Benzodiazepine Use Among Older Adults Levels Off After Years of Decline, New Study Finds

New Research Highlights Changing Prescription Trends in Older Americans

A new nationwide study has found that while benzodiazepine prescriptions among older adults in the United States declined steadily before the COVID-19 pandemic, progress has largely stalled in recent years. Researchers also observed a concerning increase in prescriptions among adults aged 75 and older, as well as those receiving care through long term care pharmacies.

These findings raise important questions about medication safety, prescribing practices, and the challenges healthcare providers face when treating anxiety and insomnia in aging populations.

What Are Benzodiazepines?

Benzodiazepines are prescription medications commonly used to treat anxiety disorders, panic attacks, insomnia, seizures, and muscle spasms. Some well known medications in this drug class include alprazolam, lorazepam, diazepam, and clonazepam.

Although these medications can be effective for short term symptom relief, they are generally not recommended for prolonged use in older adults because aging increases sensitivity to their effects. Long term use has been linked to a greater risk of falls, fractures, memory problems, confusion, motor vehicle accidents, and dependence.

For these reasons, many healthcare organizations encourage physicians to prescribe benzodiazepines cautiously in adults aged 65 years and older.

Study Examined Nearly a Decade of Prescription Data

Researchers analyzed prescription records from the IQVIA Longitudinal Prescription Claims database between January 2015 and December 2024. The database captures more than 90 percent of retail pharmacy prescriptions and approximately 75 to 80 percent of prescriptions dispensed through long term care pharmacies across the United States.

The study included more than 24.9 million adults aged 65 years and older who filled at least one benzodiazepine prescription during the study period.

Investigators evaluated several prescribing patterns, including:

• Overall benzodiazepine use
• Long term use of 180 days or more each year
• Prescriptions dispensed through long term care pharmacies
• Patient age and sex
• Prescribing specialty
• Geographic trends

This broad dataset allowed researchers to evaluate how prescribing patterns changed before and after the COVID 19 pandemic.

Benzodiazepine Prescriptions Declined Before the Pandemic

The study found encouraging progress between 2015 and 2019.

Overall benzodiazepine prescribing dropped from 14.1 prescriptions per 100 older adults in 2015 to 11.5 prescriptions per 100 people in 2024. Much of this decline occurred before the pandemic, suggesting that deprescribing initiatives and updated prescribing guidelines were having a positive effect.

Healthcare systems have increasingly emphasized reducing unnecessary benzodiazepine use because safer alternatives are available for managing anxiety and sleep disorders.

Programs promoting medication reviews and physician education may have contributed to these improvements.

Progress Slowed After COVID 19

Although prescription rates remained lower than in 2015, researchers found that the downward trend stopped after 2020.

Instead of continuing to decline, overall prescribing stabilized during the years following the pandemic.

The authors suggest several possible reasons for this shift.

The pandemic disrupted access to healthcare services, counseling, and behavioral therapies that often serve as alternatives to medication. Social isolation, increased stress, staffing shortages in healthcare settings, and greater mental health challenges may also have increased reliance on medications that provide rapid symptom relief.

While the study cannot confirm the exact causes, these factors likely influenced prescribing decisions during and after the pandemic.

Adults Aged 75 and Older Saw Increased Use

One of the most important findings involved adults aged 75 years and older.

Unlike younger seniors, prescription rates for this oldest age group began increasing after 2020.

Older adults often have multiple chronic medical conditions and may experience higher rates of anxiety, insomnia, and cognitive decline. At the same time, they are also the group most vulnerable to serious side effects associated with benzodiazepines.

Even relatively low doses can increase the likelihood of falls, fractures, confusion, and hospitalization.

These findings suggest that additional medication safety efforts may be especially important for this age group.

Long Term Care Facilities Showed Rising Prescriptions

Researchers also observed increasing benzodiazepine dispensing through long term care pharmacies.

Although long term care prescribing represented a relatively small percentage of all prescriptions, its growth after 2020 was notable.

Residents of nursing homes and assisted living facilities often have complex medical needs, making medication management particularly challenging.

The authors suggest that pandemic related staffing shortages, limited access to non drug therapies, and increased behavioral symptoms may have contributed to greater medication use in these settings.

Improving medication review programs and expanding non medication approaches could help reduce unnecessary prescribing.

Long Term Use Remains Common

Despite some improvement over time, nearly one third of older adults receiving benzodiazepines continued to use them for at least 180 days each year.

Long term use remains concerning because tolerance can develop, meaning patients may require ongoing treatment while receiving fewer benefits.

Extended use also increases the likelihood of physical dependence and withdrawal symptoms if medication is stopped suddenly.

Current clinical guidelines generally recommend using benzodiazepines for the shortest duration necessary while exploring safer long term treatment options whenever possible.

Changes in Prescribing Providers

The study also found changes in who was prescribing these medications.

Primary care physicians remained the largest group of prescribers throughout the study period. However, their share gradually declined.

At the same time, prescriptions written by advanced practice clinicians, including nurse practitioners and physician assistants, more than doubled over the study period.

This shift reflects broader changes within the healthcare workforce rather than indicating differences in prescribing quality.

What These Findings Mean

The study shows that earlier improvements in reducing benzodiazepine use among older adults have slowed.

Although prescription rates remain below levels seen a decade ago, continued vigilance is needed, particularly for adults aged 75 years and older and individuals living in long term care facilities.

Healthcare providers may benefit from regularly reviewing medications, discussing treatment goals with patients, and considering non medication approaches for anxiety and insomnia whenever appropriate.

For patients and caregivers, these findings reinforce the importance of discussing both the benefits and risks of long term benzodiazepine use with a qualified healthcare professional.

Conclusion

Benzodiazepines continue to play an important role in treating certain medical conditions, but their use among older adults requires careful consideration. This large national study suggests that the decline in prescribing seen before the COVID 19 pandemic has largely stopped, with increases observed among some of the highest risk populations.

As healthcare systems continue improving medication safety, ongoing monitoring, individualized treatment plans, and greater access to non drug therapies may help reduce unnecessary long term use while ensuring patients receive appropriate care for anxiety, insomnia, and related conditions.

Disclaimer

This article is intended for educational and informational purposes only. It should not be considered medical advice, diagnosis, or treatment. Do not start, stop, or change any medication without consulting your physician or another qualified healthcare professional.

Sources

Olfson M, Xie F, Bushnell G, Cruz N, Hua J, Miles J, Crystal S. Benzodiazepine Prescriptions to Older Adults in the United States, 2015 to 2024. Annals of Internal Medicine. 2025. DOI: 10.7326/ANNALS-25-05594.