Older Adults Still Overusing Drugs Despite Updated Medical Warnings

A doctor prescribes a medication. The patient fills it, takes it, refills it. Years pass. Medical researchers publish findings showing the drug is risky for older people, or ineffective, or both. Professional societies update their guidelines. The FDA issues warnings. And yet the prescription continues, often for far longer than it should.

This lag between what medicine knows and what medicine does is not a small problem. It plays out across millions of older Americans taking benzodiazepines for anxiety and insomnia, antibiotics for infections that don't need them, and aspirin to prevent heart disease they haven't had. The gap between evidence and practice has real consequences: falls, fractures, car crashes, overdoses, emergency room visits, bleeding in the brain.

Michael Steinman, a geriatrician at the University of California-San Francisco who directs the U.S. Deprescribing Research Network, describes medications as barnacles. They stick. Starting them is easy. Stopping them is hard. Part of the problem is simple logistics—new research takes years to reach busy clinicians who are juggling a thousand other demands. But there is something deeper too: doctors and patients alike fall into patterns. A condition gets treated a certain way, and that way becomes automatic, almost invisible. Changing course requires energy and imagination that competing priorities make hard to find.

Benzodiazepines, the class that includes Valium, Xanax, and Ativan, offer quick relief from anxiety and insomnia. That appeal has made them popular for decades. But researchers began sounding alarms more than two decades ago. These drugs impair balance and coordination. They fog cognition. In older people, who are more fragile to begin with, they translate into falls and broken bones. Combined with opioids, they can be fatal. And they create dependence—after weeks or months of use, the body adapts, and stopping them triggers withdrawal symptoms that can be severe.

So prescribing rates should have dropped sharply. Among people 65 and older, they did decline somewhat, falling from about 14 percent in 2015 to 11.5 percent in 2024, according to research published in the Annals of Internal Medicine by Columbia University psychiatrist Mark Olfson and his team. But the decline stalled after 2020, possibly because the pandemic disrupted medical routines. More troubling: among those over 75, use actually rose, from 12 percent in 2020 to about 13 percent four years later. In long-term care facilities, where the most vulnerable patients live, dispensing more than doubled. About a third of users have been taking benzodiazepines for longer than six months, the threshold where dependence becomes likely. "It's worrisome," Olfson said. He also cautioned that patients should never stop these drugs abruptly on their own—withdrawal can be dangerous. Stopping requires medical supervision and takes many weeks.

The story repeats with antibiotics. For years, the standard treatment for diverticulitis, an inflammation of small pouches in the colon, was antibiotics—fluoroquinolones like Cipro, or amoxicillin-clavulanate. "It was unquestioned," said Jesse Sutton, a pharmacist at the Minneapolis Veterans Affairs healthcare system. "Antibiotics are safe and effective, so the mindset was: when in doubt, use them." In 2015, the American Gastroenterological Association recommended against routinely prescribing antibiotics for uncomplicated diverticulitis, which accounts for the vast majority of cases. Clinical trials had shown that antibiotics did nothing to reduce death, surgery, complications, or recurrence. They simply didn't work. Yet when Sutton and colleagues studied 70,000 visits across 120 VA facilities over a decade, they found that antibiotic prescriptions remained nearly universal at 97 percent of visits. The patients would have fared just as well with acetaminophen and a clear liquid diet. Antibiotics carry their own costs: side effects send people to emergency rooms; they increase the risk of C. difficile, a dangerous infection; and overuse breeds resistance, making the drugs less effective for everyone in the future. Sutton encourages patients to ask their doctors why an antibiotic is being prescribed. If the answer is unclear, he says, it's reasonable to pause.

Aspirin tells a different story, though not a reassuring one. Unlike prescription drugs, aspirin is cheap and available over the counter, so millions of older Americans have simply started taking it on their own, convinced it will protect their hearts. For people who have already had a heart attack or stroke, daily low-dose aspirin does reduce the risk of another event. But for primary prevention—for people with no history of heart disease—the evidence shifted. In 2019, the American College of Cardiology and American Heart Association recommended against aspirin for those 70 and older. The U.S. Preventive Services Task Force went further, warning against it starting at age 60. Large trials showed minimal benefit but real harms, particularly gastrointestinal bleeding, which becomes more likely with age. Rarely but seriously, aspirin can cause bleeding in the brain. A study published last year in JAMA found that the message was getting through: aspirin use for primary prevention dropped substantially between 2011 and 2023. Yet more than a third of people 70 and older are still taking it. Timothy Anderson, an internist at the University of Pittsburgh, notes that many of these patients are motivated by genuine concern for their health. They want to be proactive. But blood pressure medications and statins for cholesterol are more effective strategies. Anderson's advice: have a conversation with your primary care doctor. Ask whether aspirin still makes sense as you age. The answer may surprise you.