🟠 Moderate Evidence
A decade-long national study led by researchers at Columbia University Mailman School of Public Health and Columbia University Irving Medical Center has found that the COVID-19 pandemic halted nearly a decade of declining benzodiazepine prescribing among older Americans. Although prescribing rates had declined steadily between 2015 and 2020, that progress plateaued after the pandemic began, with increases observed particularly among adults aged 75 and older and among patients receiving medications through long-term care pharmacies.
Key takeaways
- Benzodiazepine prescribing declined steadily from 2015 to 2020 but stalled after the COVID-19 pandemic onset
- Prescribing increased significantly among adults aged 75 and older during the pandemic period
- Long-term care pharmacy patients experienced elevated benzodiazepine use following March 2020
- This reversal represents a setback in efforts to reduce potentially harmful medication use in vulnerable older populations
Study at a Glance
| Source | Annals of Internal Medicine |
| Study type | National observational study (2015–2024) |
| Setting | United States, national prescribing patterns |
| Population | Older Americans (age 65+) |
| Primary outcome | Benzodiazepine prescribing rates before and after March 2020 |
Benzodiazepine Prescribing Trajectory in Older Americans
Prescribing rates show decline 2015–2020, followed by plateau and increase post-pandemic onset
Source: Columbia University Mailman School of Public Health / Columbia University Irving Medical Center, 2026 | Georgian Medical Journal News
A Decade of Decline Reversed
For years, geriatric prescribing guidelines have recommended minimizing benzodiazepine use in older adults due to well-documented risks including cognitive impairment, falls, fractures, and dependence. This national study, conducted by researchers at Columbia University Mailman School of Public Health, tracked prescribing patterns from 2015 through at least 2024 and observed that this hard-won progress came to an abrupt halt when the pandemic began. Before 2020, benzodiazepine prescribing rates had fallen below 2015 baseline levels, reflecting years of successful clinical and policy efforts to promote safer medication practices in older populations.
The timing of the reversal is significant. The pandemic introduced unprecedented psychological stressors—isolation, grief, economic disruption, and healthcare system strain—that likely contributed to increased anxiety, insomnia, and other conditions commonly treated with benzodiazepines. However, the study suggests this prescribing rebound may represent a concerning clinical pivot during a period when mental health support alternatives were also stressed and difficult to access. Read more about emerging clinical updates on medication safety during crisis periods.
The Oldest and Most Vulnerable Saw Largest Increases
The research identified two populations experiencing the sharpest increases in benzodiazepine prescribing post-pandemic. Adults aged 75 and older—already at higher baseline risk for adverse medication effects—experienced elevated prescribing rates following March 2020. Additionally, patients whose medications are managed through long-term care pharmacies (typically nursing home residents) saw significant increases. These are precisely the populations for which benzodiazepine-related harms are most severe and most costly to the healthcare system.
This pattern raises particular concern because older adults and long-term care residents have diminished physiological capacity to metabolize benzodiazepines safely. Slower clearance, reduced body water distribution, and polypharmacy interactions compound risks in these groups. The pandemic may have disrupted routine medication reviews and specialist oversight that typically act as safeguards in clinical practice. Explore more on pharmacy and prescribing safety issues affecting vulnerable populations.
Pandemic Stress vs. Clinical Best Practice
The study raises an important question: whether the pandemic-era prescribing increase reflects legitimate clinical need or a departure from evidence-based practice under crisis conditions. The World Health Organization has documented widespread mental health deterioration during the pandemic, including increased rates of anxiety and sleep disorders in older populations. However, clinical guidelines from the U.S. National Institute on Aging and the American Geriatrics Society Beers Criteria continue to recommend against benzodiazepines as first-line treatment for anxiety or insomnia in older adults, citing superior safety profiles of alternative medications and psychosocial interventions.
The pandemic’s disruption of healthcare infrastructure may also have reduced access to non-pharmacological treatments such as cognitive behavioural therapy, exercise programs, and structured sleep hygiene interventions—services that are often more labour-intensive and were deprioritised during acute pandemic pressures. This suggests the prescribing increases may partly reflect not genuine clinical escalation but rather constrained access to safer alternatives during a resource-stretched period.
Years of progress in reducing benzodiazepine prescribing among older Americans stalled after the onset of the COVID-19 pandemic, with prescribing increases observed particularly among adults aged 75 and older and among patients receiving medications through long-term care pharmacies.
— Columbia University Mailman School of Public Health and Columbia University Irving Medical Center (Annals of Internal Medicine, 2026)
What this means
Frequently asked questions
Why are benzodiazepines considered risky for older adults?
Benzodiazepines impair cognition, increase fall and fracture risk, and can cause dependence in older adults, who metabolise these drugs more slowly than younger people. According to the American Geriatrics Society Beers Criteria, benzodiazepines are among the medications most likely to cause harm in this population.
What safer alternatives exist for anxiety and insomnia in older adults?
Evidence supports several alternatives, including selective serotonin reuptake inhibitors (SSRIs), low-dose tricyclic antidepressants, melatonin receptor agonists, and cognitive behavioural therapy for insomnia (CBT-I). These options carry lower risks of cognitive impairment and dependence than benzodiazepines.
Should older adults stop taking benzodiazepines abruptly?
No. Abrupt discontinuation can trigger seizures and severe withdrawal symptoms. Patients should work with their healthcare provider on a gradual tapering schedule, typically reducing doses by 10–25% every 1–4 weeks, as outlined in clinical deprescribing guidance.
The Columbia study underscores a critical public health challenge: maintaining evidence-based prescribing standards during crisis periods when clinical conditions favour shortcuts. As healthcare systems emerge from the acute pandemic phase, recovering the gains made in benzodiazepine deprescribing should be an explicit priority, supported by targeted audits, clinician training, and expanded access to non-pharmacological mental health services. The data suggest that pandemic-era prescribing increases were not inevitable but rather the result of constrained resources and disrupted safeguards—circumstances that can be corrected through deliberate policy and clinical action. For additional context on medication safety across healthcare systems, see quality and safety articles at GMJ News.
Source: Pandemic onset stalled reduction of benzodiazepine use among older Americans, says study
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