Benzodiazepine prescribing plateaus after years of decline

Clinical takeaway: Continue to reassess benzodiazepine use in older adults, particularly patients aged 75 years and older and long-term care residents.

Benzodiazepines remain potentially inappropriate for many older adults because they increase the risk for falls, cognitive impairment, motor vehicle crashes, and other adverse events. A national prescribing analysis suggests that the steady decline seen before the COVID-19 pandemic has largely stalled, with concerning trends among adults aged 75 years and older and in long-term care.

Researchers analyzed national prescription claims from nearly 25 million adults aged 65 years and older between 2015 and 2024. Overall benzodiazepine prescribing fell from 14.1 to 11.5 prescriptions per 100 older adults, an 18% relative decline. However, nearly all of the improvement occurred before 2020; prescribing rates then plateaued through 2024. Long-term use (180 days or longer) continued to decline over the study period but remained common, affecting about one-third of older adults who received a benzodiazepine prescription.

The most concerning findings were in high-risk groups. Among adults aged 75 years and older, prescribing began increasing after 2020, despite earlier declines. Benzodiazepine dispensing through long-term care pharmacies also rose after the pandemic, even as overall prescribing remained below pre-2020 levels.

These findings reinforce the importance of regularly reviewing benzodiazepine therapy in older adults, particularly patients aged 75 years and older and those living in long-term care. Gradual deprescribing when appropriate and nonpharmacologic approaches for anxiety and insomnia may help reduce unnecessary long-term use.

"Benzodiazepine use among older U.S. adults decreased before the COVID-19 pandemic but plateaued thereafter, with increases among adults aged 75 years or older and recipients of LTC pharmacy dispensing. Earlier reductions in benzodiazepine use were not fully sustained," the study authors concluded.

Source: Olfson M, et al. (2026 July 7) Ann Intern Med. Benzodiazepine Prescriptions to Older Adults in the United States, 2015 to 2024