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Benzodiazepine prescribing increases in older adults

In spite of safety concerns, the use of benzodiazepines in adults aged 85 and older in emergency departments and ambulatory clinics has increased, according to data published in the Journal of the American Geriatrics Society.

Erin M. Marra , MD, department of emergency medicine, Long Island Jewish Medical Center, New Hyde Park, New York, and colleagues wrote that several guidelines have been developed, including the Beers criteria and the Screening Tool of Older Persons' Prescriptions criteria, to reduce the prescribing of benzodiazepines.

"Their use in older adults has been associated with higher rates of adverse events, such as falls, hip fracture, memory problems, delirium, daytime drowsiness, and motor vehicle crashes than in younger people," they wrote.

Marra and colleagues conducted a retrospective review of data involving patients aged 65 years and older from the National Hospital Ambulatory Medical Care Survey and the National Ambulatory Medical Care Survey from 2001 to 2010.

Results showed benzodiazepine use in adults aged 85 years and older nearly doubled from 8.9% in ambulatory clinics and 10.1% in EDs from 2001 to 2002 to 19.3% in ambulatory clinics and 17.2% in EDs from 2009 to 2010.

Additionally, older adults were more likely to be prescribed a benzodiazepine if they presented with anxiety or sleep disorder. Adults aged 65 years and older who presented with anxiety were five times more likely to be prescribed a benzodiazepine (OR = 4.8) in ambulatory clinics and more than two times more likely in an ED (OR = 2.3). They were more than two times more likely if they presented with insomnia in an ambulatory clinic (OR =2.6) and 3.5 times more likely if they presented with a sleep disorder in an ED (OR = 3.6). Adults aged 85 years and older who presented with anxiety were prescribed a benzodiazepine in 41.4% of ambulatory clinic cases and 42.2% of ED cases.

"There has been no significant decline in the prescribing of benzodiazepines in individuals aged 65 and older in ambulatory care clinics or EDs, despite the introduction of prescribing criteria," Marra and colleagues wrote. "There has been a greater increase in prescribing to the most-vulnerable population, those aged 85 years and older, than in those aged 65 to 84. Some of the most common reasons for which benzodiazepines are prescribed, especially for the oldest adults, have proven alternative treatment options, many of which have better side-effect profiles." – by Chelsea Frajerman Pardes

Disclosures: The authors reported no relevant financial disclosures.