The gap between what we know is safe and what actually happens remains wide
Each year, tens of thousands of older adults leave hospitals carrying prescriptions for benzodiazepines — medications that calm and sedate in the short term but carry serious risks when use extends beyond the acute moment. A large study spanning two decades finds that most patients do stop these drugs relatively quickly after discharge, a quiet victory for public health. Yet roughly one in seven continues use well past the point of safety, facing elevated risks of falls, cognitive decline, and dependence — a reminder that medical progress is rarely complete, and that the distance between knowing what is right and doing it remains one of medicine's oldest challenges.
- A study of over 33,000 older adults reveals that between 15 and 31 percent of hospitalized patients aged 65 and older receive benzodiazepines during their stay — a striking share of a vulnerable population.
- For most, the story ends well: the majority discontinue these sedatives quickly after leaving the hospital, sidestepping the cascade of harms that prolonged use can trigger.
- But 15 percent remain on these medications two months after discharge, and the risks they face — broken bones from falls, memory erosion, physical dependence, impaired driving — are not abstract.
- Those most at risk are identifiable: patients with chronic insomnia, signs of frailty, or newly added antidepressants and antipsychotics that complicate withdrawal.
- Researchers and clinicians are calling for structured tapering plans, medication reviews at discharge, patient education, and non-drug alternatives like cognitive behavioral therapy for insomnia to close the gap between guideline and practice.
A study tracking more than 33,000 older adults over two decades offers a portrait of partial progress. Researchers followed patients aged 65 and older who left the hospital with benzodiazepine prescriptions — medications like lorazepam and clonazepam, routinely given during acute care for anxiety, insomnia, or agitation. The encouraging finding: most patients stopped taking these drugs relatively quickly after discharge. The troubling one: roughly 15 percent were still using them two months later, and some continued far longer.
Benzodiazepines serve a real purpose in hospital settings. The danger begins when the prescription outlasts the stay. For older adults, prolonged use is linked to falls that can fracture both bones and independence, cognitive and memory decline, physical dependence, and increased accident risk. These harms compound quickly in people already navigating the vulnerabilities of age.
Published in the Journal of the American Geriatrics Society, the research identified who is most likely to remain on these medications long-term: patients with chronic insomnia, those showing signs of frailty, and people recently started on antidepressants or antipsychotics — drugs that can interact with benzodiazepines in ways that make stopping harder. Postdoctoral researcher Kevin Pritchard of Hebrew SeniorLife's Marcus Institute for Aging Research acknowledged the encouraging trend while stressing that the patients who remain on these drugs face genuine danger, often without clear guidance on how to safely taper off.
Experts recommend a layered response: targeted deprescribing for high-risk patients, regular medication reviews, patient education about the risks and the process of stopping, and nonpharmacological alternatives — cognitive behavioral therapy for insomnia, relaxation techniques — that address the conditions driving the prescriptions in the first place. The hospital discharge moment, researchers argue, is the critical juncture. For the majority, the system is working. For that remaining 15 percent, closing the gap between what guidelines recommend and what actually happens will require better execution at every level — from the pharmacist reviewing a discharge order to the patient who understands, for the first time, why stopping matters.
A new study tracking more than 33,000 older adults offers a mixed picture of progress and persistent danger. Between 2004 and early 2025, researchers watched what happened to patients aged 65 and older after they left the hospital with benzodiazepine prescriptions in hand—medications like lorazepam and clonazepam, commonly given for anxiety, insomnia, or agitation during acute care. The good news arrived first: most patients stopped taking these drugs relatively quickly after discharge. But the concern lingered in the numbers: roughly 15 percent of them were still taking benzodiazepines two months later, and some continued far longer.
Benzodiazepines work in hospitals. They calm patients, help them sleep, manage acute distress. The problem emerges when the prescription doesn't end when the hospital stay does. Prolonged use in older adults has been tied to a cascade of serious harms—falls that can shatter bones and independence, memory and cognitive decline, physical dependence that makes stopping difficult, even increased risk behind the wheel. For people already navigating the fragility that often comes with age, these risks compound quickly.
The research, published in the Journal of the American Geriatrics Society, found that between 15.9 and 31.5 percent of hospitalized older adults received benzodiazepines during their stay. That's a substantial portion of the population. The researchers identified who was most vulnerable to continuing these medications long-term: patients struggling with insomnia, those showing signs of frailty, and people who had recently started antidepressants or antipsychotics—medications that can interact with benzodiazepines in ways that complicate withdrawal.
Kevin Pritchard, a postdoctoral researcher at the Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife and one of the study's authors, framed the tension carefully. The trend toward faster discontinuation is encouraging, he said, but the patients who remain on these drugs face real danger. The challenge isn't just medical—it's behavioral and psychological. Some patients develop dependence. Others have underlying conditions, like chronic insomnia, that make them reluctant to stop. Still others simply aren't given clear guidance on how to taper off safely.
Recent guidelines from the American Society of Addiction Medicine have emphasized the importance of structured tapering after hospitalization to prevent both dependence and serious adverse effects. But knowing what should happen and making it happen in practice are different things. Pritchard and his colleagues recommended a multi-pronged approach: targeted deprescribing strategies aimed specifically at high-risk patients, regular medication reviews, patient education programs that explain both the risks and the process of stopping, substitution of longer-acting benzodiazepines with shorter-acting alternatives when needed, and nonpharmacological therapies—things like cognitive behavioral therapy for insomnia or relaxation techniques—that address the underlying conditions driving the prescriptions in the first place.
The study suggests that the hospital discharge moment is critical. It's when the prescription either continues or stops, when the patient either gets clear instructions and support or drifts into chronic use. For the majority of older adults, the system is working—they're stopping these medications and avoiding months of unnecessary risk. But for that 15 percent who continue, the gap between what we know is safe and what actually happens remains wide. Closing it will require not just better guidelines but better execution: pharmacists and physicians paying attention at discharge, patients understanding why stopping matters, and systems in place to support the difficult work of getting off a medication that has become routine.
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While it's encouraging to see more patients stopping these medications quickly, we remain concerned about the older adults who continue to use long-acting benzodiazepines because they face higher risks of falls, memory problems, and dependence.— Kevin T. Pritchard, postdoctoral research fellow at Hebrew SeniorLife
A Conversa do Hearth Outra perspectiva sobre a história
Why does it matter that some older adults keep taking these drugs after they leave the hospital? Isn't a benzodiazepine just a benzodiazepine?
The difference is context. In the hospital, you're monitored. You're there for days, maybe a week. The drug serves a purpose—it calms you during acute distress. But once you're home, living alone or with family, the calculus changes. The risks compound over time in ways they don't in a controlled setting.
What kind of risks are we talking about?
Falls, mainly. An older person on a benzodiazepine moves more slowly, has worse balance, thinks less clearly. A fall at 75 isn't like a fall at 35. It can mean a broken hip, loss of independence, a cascade into decline. There's also cognitive fog—memory problems, confusion. And dependence. The body adapts to the drug. Stopping becomes harder, not easier, the longer you take it.
So why do 15 percent of patients stay on them for two months or more?
Sometimes it's inertia. The prescription was written, it's working, nobody explicitly tells the patient to stop. Sometimes it's the underlying problem—the insomnia or anxiety that got them hospitalized in the first place. That didn't disappear when they were discharged. And sometimes it's fear. Stopping a benzodiazepine can be uncomfortable. You might sleep worse before you sleep better. Without support, people often just keep taking it.
What would actually change this?
The researchers are saying it takes more than guidelines. You need someone—a pharmacist, a nurse—sitting down with the patient at discharge and saying, here's why you need to stop, here's how we'll do it, here's what to expect, and here's what we'll do instead for your insomnia or anxiety. You need follow-up. You need alternatives ready. Right now, the default is often just to keep the prescription going.