Benzodiazepines are often prescribed to older adults for anxiety and insomnia, despite risks such as falls, motor vehicle crashes, and cognitive impairment. These concerns are especially relevant in long-term care (LTC) settings, where patients may be more medically vulnerable. This study examined U.S. benzodiazepine prescribing trends among adults aged 65 years or older from 2015 to 2024, including overall use, long-term use, and LTC pharmacy dispensing.
Investigators analyzed IQVIA Longitudinal Prescription Claims, which captured more than 90% of retail pharmacy fills and 75% to 80% of LTC pharmacy fills. Benzodiazepine use was defined as at least one prescription in a calendar year; long-term use was defined as 180 or more days’ supply.
From 2015 to 2024, nearly 25 million older adults filled at least one benzodiazepine prescription. Overall use decreased from 14.1 to 11.5 per 100 persons, but the decline occurred mainly before 2020. After the onset of the COVID-19 pandemic, prescribing plateaued. Long-term use continued to decline, while LTC pharmacy dispensing increased from 0.46 to 0.85 per 100 persons.
The oldest adults showed a concerning pattern. Among adults aged 75 years or older, benzodiazepine use decreased before the pandemic but increased after 2020. This group is particularly important for medication-safety efforts because of heightened susceptibility to adverse effects.
The authors suggest that pre-pandemic declines may reflect deprescribing efforts, quality measures, and use of alternative treatments. Post-2020 stabilization and increases in some groups may relate to social isolation, staffing shortages, reduced access to behavioral therapies, and greater reliance on rapidly acting medications during the pandemic.
These findings support renewed attention to structured medication review, nonpharmacologic management of anxiety and insomnia, and deprescribing initiatives, particularly for adults aged 75 years or older and those in LTC settings.
Fig From: Olfson, M., Xie, F., Bushnell, G., Cruz, N., Hua, J., Miles, J., & Crystal, S. (2026). Benzodiazepine Prescriptions to Older Adults in the United States, 2015 to 2024. Annals of internal medicine, 10.7326/ANNALS-25-05594. Advance online publication. https://doi.org/10.7326/ANNALS-25-05594
Reference:
Olfson M et al. Ann Intern Med. 2026 Jul 7, Epub ahead of print. Abstract.