Researchers say older adults can become dependent on medications for anxiety. Alternative treatments should be considered.
They can be prescribed as a temporary means of easing depression, improving sleep, and lowering anxiety.
Benzodiazepines, such as Xanax and Valium, are sedatives in the form of a mild tranquilizer that work by slowing down the brain and central nervous system.
They can help relax the body and reduce anxiety, but guidelines advise against extended use of the drugs, especially among the older population.
“Use of benzodiazepines by older adults have been associated with a host of potential risks including falls, fractures, motor vehicle accidents, and potentially, an increased risk of dementia. Additionally, when these types of medications are combined with other prescribed medications, such as opioids, they can increase the risk of unintentional overdoses and death,” Dr. Lauren Gerlach, a geriatric psychiatrist at the University of Michigan and lead author of the research, told Healthline.
Gerlach and her colleagues examined the use of benzodiazepines in older, low-income adults.
The researchers interviewed patients who weren’t living in nursing homes or skilled nursing facilities. They also screened them for mental health issues, as well as gathered data on their prescription history.
Out of the 576 patients studied who were given their first prescription for benzodiazepine between 2008 and 2016, 152 of those patients still had a prescription a year later.
Although guidelines state benzodiazepines should rarely be prescribed to adults over the age of 65, the average age of those receiving their first benzodiazepine prescription was 78.
Only a few of the patients had received any psychiatric or psychological care in the previous two years. All had been prescribed the medications by a nonpsychiatrist, such as a primary care physician.
“The vast majority of mental healthcare, and prescribing of psychiatric medications such as benzodiazepines to older adults, is by primary care physicians and other nonpsychiatrists. Since mental health providers see only a very small minority of older adults who have mental health issues, we need to support primary care providers better as they manage these patients’ care,” Gerlach said.
Patients who were white were four times as likely to continue with long-term use of the drugs.
The initial amount prescribed also made a difference.
“We found that nonclinical factors such as patient race and the days’ supply in the initial prescription were strongly associated with conversion to long-term use. For just every 10 additional days of medication prescribed, a patient’s risk of long-term use nearly doubled over the next year,” Gerlach said.
Poor sleep was one of the factors associated with continued use of the medications.
This is despite the fact that guidelines suggest against using such drugs as long-term sleep aids.
It’s believed benzodiazepines might actually worsen rather than improve sleep with long-term use.
Dr. Grace Cheng is a geriatric pharmacist at the University of California Los Angeles (UCLA).
She says that patients can become dependent on sedatives after seeing a quick improvement of their symptoms.
“Benzodiazepines can be a rapid solution for debilitating symptoms, such as the inability to fall asleep and resolution of an acute panic attack, which leads to patients’ satisfaction and perceived benefits of therapy. This may result in dependence and longer duration of use. However, they do not address the chronic management of insomnia, anxiety, and depression,” Cheng told Healthline.
Cheng says there are occasions where prescribing benzodiazepines may be appropriate, but as many older adults are prescribed these drugs to deal with anxiety, insomnia, or panic disorders, there are other treatment options that should be considered.
“There are more evidence-based pharmacological and nonpharmacological interventions that need to be explored prior to the use of benzodiazepines. Benzodiazepines should be reserved for when other treatments are not available or effective, but just as importantly, the discussion regarding the safety of these medications should occur prior to prescribing them,” she said.
Dr. Peter Pompei is a geriatrician at Stanford University.
He says physicians should be making more of an effort to adhere to guidelines on benzodiazepines.
“Physicians want to meet their patients’ needs, and too often ignore the guidelines. More awareness of the hazards of these drugs is important for physicians caring for older persons,” he told Healthline.
Gerlach says that although the prescription of sedatives may start out well-intentioned, long-term use can be difficult to address due to patient dependence.
Both patients and providers may then be hesitant to discontinue treatment as they feel alternatives won’t be as effective.
She says physicians should have a long-term plan in mind when prescribing a benzodiazepine, paying particular attention to the amount prescribed.
“We need to help providers start with the end in mind when prescribing a benzodiazepine, by beginning with a short-duration prescription and engaging patients in discussions of when to reevaluate their symptoms and begin tapering the patient off. Since chronic benzodiazepine use is rarely the goal when a new benzodiazepine is started, clinicians may decrease the likelihood of long-term use by limiting the amount of medication they provide in that initial prescription,” Gerlach said.
As well as this, improving education for other non-pharmacological treatment, such as cognitive behavior therapy, will enable physicians to feel they can provide their patients with alternatives to sedatives.
If benzodiazepines are prescribed, Cheng says it is essential physicians continue to check in with their patients to minimize risk of long-term use.
“It is important that there is adequate communication and close follow-up with patients taking these medications. If the benzodiazepine is being prescribed for more short-term reasons, healthcare providers should include, as part of the discussion, the expected duration of therapy,” she said.
“If the benzodiazepine is being used for anxiety and panic disorder management, the role of benzodiazepines should be reserved for acute management of anxiety and panic symptoms on an as-needed basis. Healthcare providers should discuss options for the chronic management of anxiety and panic disorders during the same visit, as well as set up routine follow-up to evaluate for the efficacy, adherence, and safety of the medications,” she added.