Use of Anti-Anxiety Drugs Increases with Age, Despite Risks

NIH-Funded Study First to Identify National Prescribing Patterns of Benzodiazepines

Despite the risks of confusion and falls associated with benzodiazepine use by the elderly, a Columbia-led study finds that prescriptions for benzodiazepines increase as people age. The research, published in JAMA Psychiatry, provides the first estimates of usage patterns in the United States.

Benzodiazepines, which include Xanax, Valium, and Ativan, are used to treat anxiety and sleep problems and are one of the most commonly prescribed classes of medications in developed countries.

Senior author Mark Olfson, MD, and his co-authors reviewed data from a national prescription database on benzodiazepine prescription patterns from 2008. They found that among all adults ages 18 to 80, about 11.5 million, or 5 percent, received a benzodiazepine prescription that year. The percentage increased with age, from 2.6 percent for those 18 to 35 to 8.7 percent for those 65 to 80, the oldest group studied.

According to Dr. Olfson, professor of psychiatry at CUMC and a research psychiatrist at the New York State Psychiatric Institute, nearly one-third of adults ages 65 and older who use benzodiazepines continue on them for at least four months. Such long-term use is associated with decreased effectiveness of the medication and increased risk of physical dependence on it.

“These prescribing patterns likely put a large number of older adults at unnecessary risk of falls, motor vehicle accidents, and confusion,” says Dr. Olfson. The numbers also suggest people are at risk for benzodiazepine abuse. “As life expectancy increases and the population ages,” says Dr. Olfson, “an increasing number of older adult Americans will face these risks from long-term benzodiazepine use unless steps are taken to promote safer alternative treatments.”

Also of potential concern, the study showed that only around 10 percent of adults ages 65 to 80 who were treated with benzodiazepines long term received any of their benzodiazepine prescriptions from psychiatrists, physicians who specialize in the assessment and treatment of mental disorders.

“We hope that these findings will serve as an impetus for health care professionals to teach older adults with anxiety or insomnia about non-pharmacological approaches to relieving stress and promoting healthy sleep,” says Dr. Olfson. “Examples include increasing light-to-moderate exercise, promoting supportive relationships, ensuring adequate exposure to natural light, avoiding stimulants such as caffeine late in the day, avoiding naps, establishing a regular relaxing bedtime routine, and accepting that quality of sleep naturally tends to decline as we age.”

Other contributors to the paper are Marissa King, PhD, Yale University, and Michael Schoenbaum, PhD, National Institute of Mental Health.