Researchers have warned for decades about risks associated with benzodiazepines and related “Z” drugs prescribed for anxiety and insomnia. These agents — including Valium, Xanax, Ativan, Ambien, and Lunesta — can impair balance, coordination, and cognition in older adults, contributing to falls, fractures, and motor vehicle accidents. In patients taking opioids, benzodiazepines increase the risk of overdose.
Dependence is another key concern: prolonged use raises the likelihood of physiological dependence and withdrawal symptoms when the drug is stopped. Because of these harms, professional groups and drug-safety authorities have issued cautions and updated guidance over time.
A recent analysis published in the Annals of Internal Medicine documented partial progress: among people aged 65 and older, the proportion filling prescriptions for benzodiazepines fell from about 14% in 2015 to 11.5% in 2024. However, that decline has largely stalled since 2020, and use actually increased among those older than 75 (rising from about 12% in 2020 to roughly 13% in 2024). Dispensing through pharmacies in long-term care facilities more than doubled, and approximately one-third of users had been taking benzodiazepines for longer than six months—an interval associated with greater dependence risk.
Experts underscore that patients should not stop benzodiazepines abruptly because withdrawal can be dangerous. Supervised tapering with a clinician is required and often takes many weeks.
Antibiotics have long been the default treatment for infections, but evidence and guidelines have shifted for some conditions common in later life. One example is uncomplicated diverticulitis. Clinical trials showed antibiotics had little or no effect on mortality, need for surgery, complications, or recurrence for most uncomplicated cases. In 2015 the American Gastroenterological Association recommended against routine antibiotics for uncomplicated diverticulitis, and other specialty groups issued similar guidance.
Despite those recommendations, a large study of 70,000 visits to 120 Veterans Affairs facilities reported in the Annals of Internal Medicine found that antibiotic prescribing remained nearly universal — about 97% of visits — over a 10-year span. Many patients with uncomplicated diverticulitis would likely have done as well with symptomatic care such as a brief period of clear liquids and acetaminophen rather than antibiotics.
Beyond diverticulitis, antibiotics are frequently prescribed for asymptomatic bacteriuria in older adults and for upper respiratory infections that are usually viral. Such overuse carries direct harms: adverse drug reactions leading to emergency department visits, increased risk of Clostridioides difficile infection, and the broader public health problem of antimicrobial resistance. The World Health Organization has identified antimicrobial resistance as a major global threat.
When offered antibiotics, clinicians and patients are encouraged to discuss the rationale; in some cases pressing pause or seeking clarification about expected benefits and risks is reasonable.
Aspirin use in older adults varies by purpose. For secondary prevention — people who have had a heart attack, stroke, or coronary revascularization — daily low-dose aspirin reduces the risk of subsequent events and is an established therapy.
However, the role of aspirin for primary prevention (preventing a first cardiovascular event) has changed. The American College of Cardiology and the American Heart Association in 2019 recommended against aspirin for primary prevention in adults aged 70 and older. The U.S. Preventive Services Task Force set an even earlier age threshold, advising against routine aspirin for primary prevention beginning at age 60. Large clinical trials found minimal benefit for primary prevention while demonstrating increased risk of major bleeding, including gastrointestinal bleeding and rarer but serious intracranial hemorrhage; bleeding risk rises with age.
A JAMA analysis reported that aspirin use for primary prevention declined substantially between 2011 and 2023, indicating that guideline messages have influenced behavior. Still, the analysis found that more than one-third of adults aged 70 or older continued to take aspirin for primary prevention.
The aspirin story is nuanced. Some older adults with elevated cardiovascular risk profiles may still derive net benefit from aspirin for primary prevention, and discontinuation can be complicated: some evidence indicates stopping aspirin might be associated with higher cardiovascular risk for certain patients. This creates the need for individualized assessment.
Experts recommend that older adults discuss ongoing aspirin use with their primary care clinician to decide whether continuing, modifying, or stopping aspirin remains appropriate as risk profiles change and in the context of safer, evidence-based alternatives such as blood pressure control and statin therapy for cardiovascular risk reduction.
Across these three examples, a pattern emerges: emerging evidence and guideline changes often identify reduced benefit or increased harm of common treatments in older adults, yet practice change is uneven. Contributing factors include clinician workload and competing priorities, entrenched habits by clinicians and patients, and the difficulty of finding acceptable alternatives.
Clinical implications highlighted in the source include the need for explicit conversations between clinicians and older patients about the indications, benefits, and harms of ongoing medications; the importance of supervised tapers for agents with dependence potential (notably benzodiazepines); and careful application of guideline recommendations to individual patient risk profiles (as with aspirin).
The examples also underscore system-level challenges: even when professional societies revise guidance or the Beers Criteria add cautions, real-world prescribing may lag or diverge, and in some settings use can even increase. Monitoring prescribing trends and supporting clinicians and patients to deprescribe where appropriate remain priorities.
The content summarized here is drawn from reporting that cites recent trend analyses, randomized trials, specialty guidance, and statements by experts. Specific studies and policy statements referenced in the source include analyses published in the Annals of Internal Medicine and JAMA, guidance from the American Gastroenterological Association, the American College of Cardiology/American Heart Association, and recommendations from the U.S. Preventive Services Task Force.
Where the source provided study results, trends, or guideline recommendations, those findings were reported. If more granular details such as exact numerical effect sizes, confidence intervals, or all subgroup findings were not presented in the original article, those specifics are not included here because they were not reported in the source.