Years of progress in reducing benzodiazepine prescribing among older Americans stalled after the onset of the COVID-19 pandemic, according to a decade-long national study from Columbia University Mailman School of Public Health and Columbia University Irving Medical Center.
Although benzodiazepine prescribing declined steadily before 2020 and remained below 2015 levels, those reductions leveled off after the pandemic began. Prescribing increased among adults aged 75 years or older and among patients receiving medications through long-term care pharmacies. The findings are published in Annals of Internal Medicine.
"Our findings suggest that the COVID-19 pandemic may have disrupted progress in reducing benzodiazepine use among older adults," said Mark Olfson, MD, MPH, professor of Epidemiology at Columbia University Mailman School of Public Health. "This is concerning because older adults are especially vulnerable to the medications' adverse effects." Olfson is also professor of Psychiatry at Columbia Vagelos College of Physicians and Surgeons.
Benzodiazepines are commonly prescribed to treat anxiety and insomnia but are generally recommended only for limited use in older adults because they increase the risk of falls, cognitive impairment, motor vehicle crashes, and other serious adverse events. Older adults receiving long-term care are particularly vulnerable because of frailty, multiple chronic conditions, and prolonged medication use.
The researchers analyzed IQVIA Longitudinal Prescription Claims from January 2015 through December 2024, representing more than 90 percent of U.S. retail pharmacy prescriptions and approximately 75 to 80 percent of long-term care pharmacy dispensing. The study included nearly 25 million adults aged 65 years and older who filled at least one benzodiazepine prescription during the study period. About two-thirds of patients receiving prescriptions were women.
The researchers suggest several factors may have contributed to the change after 2020, including social isolation, staffing shortages in long-term care facilities, reduced access to behavioral therapies, and greater reliance on medications during the pandemic. Previous studies have also documented worsening depression symptoms and greater use of psychotropic medications among nursing home residents during this period.
"Although our study cannot determine what caused prescribing patterns to change after 2020, the findings suggest the importance of continuing medication safety efforts for older adults, particularly those aged 75 and older and those receiving long-term care," Olfson said. "Regular medication reviews and greater access to effective non-pharmacologic treatments may help reduce unnecessary benzodiazepine use while ensuring that patients continue to receive appropriate care."
The authors conclude that adults aged 75 years and older and individuals receiving medications through long-term care pharmacies should remain priority populations for medication safety initiatives. Structured medication reviews, expanded access to non-drug therapies, and quality improvement programs may help sustain reductions in potentially inappropriate benzodiazepine use.
Co-authors are Fangzhou Xie, Rutgers University; Greta Bushnell, Naomi Cruz, Jialiang Hua and Stephen Crystal, Rutgers University Institute for Health, Health Care Policy & Aging Research, and School of Public Health; Jennifer Miles, Rutgers University Institute for Health, Health Care Policy & Aging Research, School of Public Health; and Department of Family Medicine and Community Health, Robert Wood Johnson Medical School.
The study was supported by AHRQ R01-HS026001 and NCATS UM1TR004789. IQVIA Longitudinal Prescription data were provided by the Preparedness and Treatment Equity Coalition and IQVIA.
Financial disclosures are published in the article online.
Columbia University Mailman School of Public Health
