The scenario usually plays out this way: Researchers study a commonly used medication and conclude that it is less effective for older patients than previously thought, or that its risks outweigh its benefits for this group. Then more studies appear that confirm these findings.
After a few years, medical associations revise their guidelines and warn that the drug in question should be avoided or at least prescribed more selectively. It can be incorporated into the Beers Criteria, an influential list of potentially inappropriate drugs for older patients published by the American Geriatrics Society.
If the drug has a preventive role, the US Preventive Services Task Force, an independent panel of experts, can issue cautionary recommendations. The Food and Drug Administration (FDA) may require that the remedy’s box include a black box with warnings about worrisome side effects.
After a few years, researchers analyze large national databases to determine whether use of that drug has decreased. Often the answer is: yes, but not enough.
In fact, sometimes their usage didn’t go down at all. Or even increased.
“People tend to use a medication even when they no longer need it,” said Michael Steinman, a geriatrician at the University of California-San Francisco and co-director of the US Deprescribing Research Network. “It’s easy to start taking them, but it can be difficult to stop.”
This medical inertia reflects, in part, the time it takes to disseminate new findings. “Doctors have a million things they need to know and pay attention to, and it can take a while for the information to reach them,” Steinman said.
But it also reflects the way “doctors and patients become accustomed to treating diseases in certain ways,” he said. “They become ingrained habits.” Finding alternatives is difficult, so “it is easy to continue doing what you already know.”
Recent studies on three medications or classes of medications widely used among older Americans illustrate the problem.
Disadvantages of benzodiazepines
Scientists began warning about benzodiazepines more than 20 years ago. Prescribed for insomnia and anxiety, “they offer quick relief,” said Mark Olfson, a psychiatrist and epidemiologist at Columbia University.
The problem? Benzodiazepines — including Valium, In patients also taking opioids for pain, benzodiazepines may cause overdose.
Additionally, “once you’ve taken them for a while, you develop dependence,” Olfson added. “When you stop them, you can have withdrawal symptoms.”
So what has happened to the use of benzodiazepines among older adults, who are more sensitive to these effects?
In a recent analysis of recipe trends published in Annals of Internal MedicineOlfson and his team reported progress. Among people aged 65 and older, the proportion of patients filling prescriptions for benzodiazepines decreased from about 14% in 2015 to 11.5% in 2024.
But that decline has stalled since 2020, possibly related to the COVID-19 pandemic. Additionally, use of these prescription medications increased among people over 75, from 12% in 2020 to about 13% four years later. Dispensing through long-term care facility pharmacies more than doubled.
And about a third of those using them were taking these medications for more than six months, increasing the likelihood of developing dependence.
“It’s concerning,” Olfson said.
But he cautioned that patients should not stop taking benzodiazepines suddenly or on their own, because that can cause withdrawal symptoms.
“A gradual, supervised taper is required” by a medical professional, he said. “It takes many weeks.”
Excess antibiotics
For years, the standard treatment for diverticulitis—the inflammation or infection of small pouches that form in the colon—was antibiotics, primarily fluoroquinolones, such as Cipro and Levaquin, or amoxicillin with clavulanic acid, such as Augmentin.
“It wasn’t in question,” said Jesse Sutton, a pharmacist and researcher at the Veterans Affairs health care system in Minneapolis. “Antibiotics are safe and effective, excellent, life-saving medications, so the mentality was: when in doubt, use them.”
But in 2015, the American Gastroenterological Association recommended against routinely prescribing antibiotics for “uncomplicated” diverticulitis, which accounts for the vast majority of cases. Other medical groups made similar recommendations.
Clinical trials had shown that, for this condition, antibiotics had little or no effect on mortality, need for surgery, complications or recurrences.
“They hadn’t improved at all,” Sutton said.
And, as with any medication, “there are downsides, unintended consequences,” he said. “Antibiotic side effects account for a considerable number of emergency room visits” for symptoms such as nausea, vomiting and diarrhea.
Antibiotics also increase the risk of developing the dangerous C. difficile.
Additionally, “the more antibiotics are used, the less effective they are in the future,” Sutton said. The World Health Organization has called antimicrobial resistance “a major threat to global health.”
So Sutton and his colleagues, who studied treatments given during 70,000 visits at 120 Veterans Affairs centers, expected to see a decline in antibiotic use for uncomplicated diverticulitis over 10 years.
Instead, they recently reported in Annals of Internal Medicine that the prescription of antibiotics remained practically universal, in 97% of consultations, regardless of what the guidelines indicated.
Most likely, the patients would have done just as well with a few days of Tylenol and a clear liquid diet.
Overuse of antibiotics also remains common for other conditions that appear at older ages, including certain types of urinary tract infections that do not cause bothersome symptoms and upper respiratory tract infections, which are usually viral rather than bacterial.
In those cases, when a doctor prescribes an antibiotic, “I would advise patients to say, ‘Please explain to me the reason for prescribing it,’” Sutton said. “If they don’t, it’s okay to take a break.”
When aspirin is not the answer
Aspirin is different. Because it’s cheap and sold without a prescription, anyone can start taking it on their own, and millions of older Americans do so thinking it will help prevent cardiovascular problems.
For people who have already had a heart attack, stroke, or heart surgery, such as having a stent or bypass surgery, studies have shown that taking a low-dose aspirin daily as “secondary prevention” reduces the chance of having another episode.
But for “primary prevention” in people who have not had one of these events, the recommendations changed in 2019, when the American College of Cardiology and the American Heart Association recommended against using aspirin for this purpose in people 70 years and older.
The US Preventive Services Task Force went further and recommended not starting aspirin use for primary prevention after age 60.
Large clinical trials had shown that aspirin offered little benefit as a primary prevention measure, but did present risks, particularly gastrointestinal bleeding.
“As we age, the risk of bleeding increases,” said Timothy Anderson, an internist at the University of Pittsburgh and co-director of its Prescribing Wisely Lab.
Less commonly, but more seriously, aspirin can cause brain hemorrhages.
In a study published last year in JAMAAnderson and her co-author found signs that the message was getting through: Aspirin use for primary prevention, according to data from the National Health and Nutrition Examination Survey, declined sharply between 2011 and 2023. However, more than a third of people age 70 and older were still taking it.
There are some caveats. A subgroup of older adults with elevated risk factors for cardiovascular disease may benefit from aspirin for primary prevention.
And, to complicate matters further, some evidence suggests that older patients already taking aspirin face a higher risk of cardiovascular disease if they stop taking it.
“The first step is to talk to your primary care doctor” about aspirin, Anderson said. “’Is it still right for me as I get older?’”
Older patients who take aspirin, many of them without any medical guidance, “are interested in reducing their risk of heart attack and stroke,” he said. “They are trying to be proactive and take care of their health.”
But with blood pressure medications and statins to control cholesterol, he added, “we have better strategies than aspirin to do this.”
The New Old Age is produced in collaboration with The New York Times.
is a national newsroom producing in-depth journalism on health issues, and one of KFF’s flagship programs: the independent source for health policy research.
