Full Breakdown
Overuse of Common Medications Among Older Adults
By Drooid · · How we work
Scope of the Problem
Older Americans continue to use several drugs at rates that exceed current clinical guidance. Benzodiazepines and related “Z” drugs, antibiotics for uncomplicated diverticulitis, and low-dose aspirin for primary cardiovascular prevention are each cited as being prescribed far more often than evidence-based recommendations suggest. The persistence of these prescribing patterns reflects both clinical inertia and patient expectations about medication benefits.
Prescription Trends and Data
- Benzodiazepines – Dr. Mark Olfson reports that the share of adults >= 65 filling a benzodiazepine prescription fell to 11.5 % in 2024 from roughly 14 % in 2015, but the decline stalled after 2020. Among those > 75, use rose from 12 % in 2020 to about 13 % four years later. Dispensing through long-term-care pharmacies more than doubled, and roughly one-third of users continued the drug for longer than six months.
- Antibiotics for uncomplicated diverticulitis – A study of 70,000 VA visits found that 97 % of encounters resulted in an antibiotic prescription, despite guideline recommendations against routine use.
- Aspirin for primary prevention – National Health and Nutrition Examination Survey data show a substantial drop in aspirin use for primary prevention from 2011 to 2023, yet more than one-third of adults >= 70 still take it regularly.
Expert Commentary
Dr. Michael Steinman notes that “medications are like barnacles,” emphasizing how easy it is to start a drug and hard to stop it. He attributes the lag in practice change to clinicians juggling many priorities. Dr. Olfson warns that benzodiazepines can impair balance, increase fall risk, and cause dependence, especially when combined with opioids. Pharmacist Jesse Sutton highlights the downstream harms of unnecessary antibiotics, including emergency-room visits and heightened *C. difficile* infection risk, and urges patients to ask for the rationale behind prescriptions. Timothy Anderson points out that while aspirin’s primary-prevention role has been de-emphasized, many older adults still self-prescribe it, seeking “proactive” heart protection despite better alternatives such as blood-pressure control and statins.
Verbatim Quotes
- “Clinicians have a million things they need to know and attend to, and information may take a while to get to them,” — Michael Steinman, a geriatrician at the University of California-San Francisco and co-director of theU
- “I’d encourage patients to say, ‘Please explain the rationale for doing this,’” — Jesse Sutton, a pharmacist and researcher at the Minneapolis Veterans Affairs healthcare system
Implications for Older Patients
The data suggest that many older adults remain exposed to medication risks that outweigh proven benefits. Clinicians are encouraged to review each patient’s regimen, discuss the limited value of continued benzodiazepine or aspirin use, and consider non-pharmacologic alternatives where appropriate. Patients are advised to ask providers to explain the purpose of any prescribed drug, creating an opportunity to reduce unnecessary exposure and improve overall safety.