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. 2016 Dec;64(12):2546-2553.
doi: 10.1111/jgs.14379. Epub 2016 Nov 23.

No End in Sight: Benzodiazepine Use in Older Adults in the United States

Donovan T Maust  1   2   3 , Helen C Kales  1   2   3 , Ilse R Wiechers  4   5 , Frederic C Blow  1   2   3 , Mark Olfson  6   7
Affiliations

No End in Sight: Benzodiazepine Use in Older Adults in the United States

Donovan T Maust et al. J Am Geriatr Soc. 2016 Dec.

Abstract

Objectives: To establish the rate of new and continuation of benzodiazepine use in older adults seen by nonpsychiatrist physicians and to identify subpopulations at risk of new and continuation benzodiazepine use.

Design: Cross-sectional analysis.

Setting: National Ambulatory Medical Care Survey (2007-10).

Participants: Adults visiting office-based nonpsychiatrist physicians (n = 98,818) who were prescribed a benzodiazepine (new or continuation).

Measurements: Percentage of benzodiazepine visits of all outpatient encounters according to patient age and corresponding annual visit rate per 1,000 population. Analysis was then limited to adults aged 65 and older, demographic, clinical, and visits characteristics were used to compare visits of benzodiazepine users with those of nonusers and visits of continuation users with those of new users.

Results: The overall proportion of benzodiazepine visits ranged from 3.2% (95% confidence interval (CI) = 2.7-3.7) of those aged 18 to 34 to 6.6% (95% CI = 5.8-7.6) of those aged 80 and older, and the proportion of continuation visits increased with age, rising to 90.2% (95% CI = 86.2-93.1) of those aged 80 and older. The population-based visit rate ranged from 61.7 (95% CI = 50.7-72.7) per 1,000 persons in the youngest adults to 463.7 (95% CI = 385.4-542.0) in those aged 80 and older. Only 16.0% (95% CI = 13.5-18.8) of continuation users had any mental health diagnosis. Of all benzodiazepine users, fewer than 1% (95% CI = .4-1.8) were provided or referred to psychotherapy, and 10.0% (95% CI = 7. 2-13.3) were also prescribed an opioid.

Conclusion: In the United States, few older adult benzodiazepine users receive a clinical mental health diagnosis, and almost none are provided or referred to psychotherapy. Prescribing to older adults continues despite decades of evidence documenting safety concerns, effective alternative treatments, and effective methods for tapering even chronic users.

Keywords: anxiety; benzodiazepine; insomnia; psychotropic.

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Conflict of interest statement

Dr. Olfson is principal investigator of a grant to Columbia University from Sunovion Pharmaceuticals. Otherwise, the authors have no conflicts to disclose.

Figures

Figure 1
Figure 1
Annual population-based visit rates by age group for new and continuation benzodiazepine use among patients of non-psychiatrist physicians in the U.S. from 2007–2010 (n=5,205).
See this image and copyright information in PMC

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