Ann Arbor, MI—While benzodiazepine sedatives often are prescribed for a short-term purpose in older adults, about a fourth of those patients end up using them long term, a new study reports.

The report in JAMA Internal Medicine notes that those extended-sedative users are in addition to the one-third of patients, usually older adults, who are initially provided longer term prescriptions.

University of Michigan–led researchers point out that treatment guidelines recommend only short-term benzodiazepines. In an effort to reduce overall benzodiazepine use in older adults, the researchers sought to determine what factors lead to conversion from short- to long-term prescribing.

The drugs, such as Valium or Xanax, might be prescribed short-term for anxiety, sleep issues, or depression. When patients start taking them longer term, however, risks such as automobile accidents, falls, and fractures increase, study authors emphasize.

The study team focused on transition to long-term benzodiazepine use among 576 patients newly prescribed the drug class by a nonpsychiatric clinician from 2008 to 2016 as part of Pennsylvania’s prescription-assistance program for low-income older adults.

Participants, with a mean age of 78.4 years initiating a benzodiazepine for the first time in a year, were contacted for clinical assessment by a telephone-based behavioral health service. As part of the assessment, patients were screened for depression, anxiety, sleep quality, and pain.

For purposes of the study, long-term benzodiazepine use was defined as a medication possession ratio (MPR) greater than 30% in the year following the initial prescription, and 26.4% of the patients were identified as falling into that category.

Those participants were prescribed a mean (SD) of 232.7 benzodiazepine days. Associated with increased long-term benzodiazepine use in adjusted analyses were white race (odds ratio [OR], 4.19; 95% CI, 1.51-11.59), days supplied the index prescription (OR, 1.94; 95% CI, 1.52-2.47), and poor sleep quality (OR, 4.05; 95% CI, 1.44-11.43). A link between high anxiety and depression and long-term benzodiazepine use was not indicated, however.

The study team points out that patients whose initial prescriptions were written for the largest amounts were also more likely to become long-term benzodiazepine users: for every 10 additional days of medication prescribed, a patient’s risk of long-term use nearly doubled over the next year.

“This shows that we need to help providers start with the end in mind when prescribing a benzodiazepine, by beginning with a short-duration prescription and engage patients in discussions of when to reevaluate their symptoms and begin tapering the patient off,” explained lead author Lauren Gerlach, DO, MSc, a geriatric psychiatrist at U-M. “We also need to educate providers about effective non-pharmaceutical treatment alternatives, such as cognitive behavioral therapy, for these patients.”

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