The script often unfolds similar this: Medical researchers analyse a often utilized cause and study that it’s little effectual for older patients than antecedently thought, oregon that its risks outweigh its benefits successful older adults. More studies follow, confirming those findings.
After a fewer years, aesculapian associations revise their guidelines, informing that the cause successful question should beryllium avoided oregon astatine slightest prescribed much selectively. It mightiness beryllium added to the Beers Criteria, an influential database of perchance inappropriate medications for older patients, published by the American Geriatrics Society.
If the drug’s relation is preventive, the U.S. Preventive Services Task Force, an autarkic adept panel, mightiness measurement successful with cautions. The FDA mightiness contented “black box” warnings astir concerning broadside effects.
After a fewer much years, researchers look astatine wide nationalist information to spot whether usage of this cause declined. Often, the reply is: Yes, but not enough. Sometimes, though, usage did not diminution overmuch astatine each oregon really increased.
“Medications are similar barnacles,” said Michael Steinman, a geriatrician astatine the University of California, San Francisco and co-director of the U.S. Deprescribing Research Network. “They’re casual to start, but they tin beryllium hard to stop.”
This aesculapian inertia partially reflects the clip lag progressive successful disseminating findings.
“Clinicians person a cardinal things they request to cognize and be to, and accusation whitethorn instrumentality a portion to get to them,” Steinman said.
But it besides reflects the mode “clinicians and patients get utilized to treating conditions successful definite ways,” helium said. “They go ingrained habits.” Finding alternate approaches is challenging, truthful “it’s casual to spell with what you know.”
Recent studies of 3 medications oregon classes of drugs wide utilized among older Americans exemplify the problem.
Drawbacks of benzodiazepines
Scientists began raising alarms astir benzodiazepines much than 20 years ago. Prescribed for insomnia and anxiety, “they connection punctual relief,” said Mark Olfson, a psychiatrist and epidemiologist astatine Columbia University.
The problem? Benzodiazepines (including Valium, Xanax and Ativan) and the related “Z” drugs (Ambien, Lunesta) mightiness impair balance, coordination and cognition that tin construe into falls and fractures and centrifugal conveyance accidents, Olfson said. In patients besides taking opioids for pain, benzodiazepines tin origin overdoses.
Moreover, erstwhile you’ve taken them for a play of time, you make a dependence, Olfson added. “When you travel disconnected them, you whitethorn make withdrawal symptoms.”
So what has happened to benzo usage among older adults, who are much delicate to these effects? In a caller introspection of prescribing trends, published successful the Annals of Internal Medicine, Olfson and his squad reported progress. Among radical 65 and older, the complaint of patients filling prescriptions for benzos dropped to 11.5 percent successful 2024, from astir 14 percent successful 2015.
But that diminution has stalled since 2020, possibly related to the COVID-19 pandemic. Moreover, prescribed usage really roseate among those implicit 75, from 12 percent successful 2020 to astir 13 percent 4 years later. Dispensing done pharmacies successful semipermanent attraction facilities much than doubled. And astir a 3rd of users were taking the cause for longer than six months, expanding the likelihood of dependence. “It’s worrisome,” Olfson said.
But Olfson cautioned that patients should not halt benzodiazepines abruptly oregon connected their own, which tin provoke withdrawal. “It requires supervised tapering” with a aesculapian professional, helium said. “It takes galore weeks.”
Overprescribing antibiotics
For years, the modular attraction for diverticulitis, the inflammation oregon corruption of tiny pouches that signifier successful the colon, was antibiotics, chiefly fluoroquinolones (like Cipro and Levaquin) oregon amoxicillin-clavulanate (Augmentin).
“It was unquestioned,” said Jesse Sutton, a pharmacist and researcher astatine the Minneapolis Veterans Affairs healthcare system. “Antibiotics are harmless and effective, great, lifesaving drugs, truthful the mindset was: When successful doubt, usage them.”
But successful 2015, the American Gastroenterological Association recommended against routinely prescribing antibiotics for “uncomplicated” diverticulitis, which represents a large bulk of cases. Other aesculapian groups followed suit.
Clinical trials had shown that, for this condition, antibiotics had small oregon nary effect connected mortality, the request for surgery, complications oregon recurrences. “They hadn’t improved anything,” Sutton said.
As with immoderate drug, “there are downsides, unintended consequences,” helium said. “Side effects from antibiotics relationship for a important magnitude of exigency country visits” for symptoms specified arsenic nausea, vomiting and diarrhea. Antibiotics heighten the hazard of the virulent C. difficile infection, too.
Plus, “the much you usage antibiotics, the little they enactment successful the future,” Sutton said. The World Health Organization has deemed antimicrobial absorption “a large planetary wellness threat.”
So Sutton and his colleagues, studying attraction successful 70,000 visits to 120 VA facilities, expected to spot antibiotic usage for uncomplicated diverticulitis diminution implicit 10 years.
Instead, they reported precocious successful the Annals of Internal Medicine that antibiotic prescriptions remained astir cosmopolitan astatine 97 percent of visits, guidelines oregon nary guidelines. The patients would astir apt person done arsenic good with a fewer days of Tylenol and a wide liquid diet.
Antibiotic overuse remains communal for different conditions of aboriginal life, too, including the benignant of urinary tract infections that origin nary troublesome symptoms and precocious respiratory infections that are typically viral, not bacterial.
In specified cases, erstwhile a doc prescribes an antibiotic, “I’d promote patients to say, ‘Please explicate the rationale for doing this,’” Sutton said. “If they don’t, it’s OK to property pause.”
When aspirin isn’t the answer
Aspirin is different. Because it’s inexpensive and sold implicit the counter, anybody tin commencement taking it connected their ain — and millions of older Americans do, reasoning it volition assistance forestall cardiac problems.
For radical who already person had a bosom attack, changeable oregon cardiac involution specified arsenic a stent oregon bypass surgery, regular low-dose aspirin for “secondary prevention” does little the likelihood of different event, studies person demonstrated.
But for “primary prevention” successful radical who person not had one, the guidelines changed successful 2019, erstwhile the American College of Cardiology and the American Heart Association recommended against aspirin for this intent successful those 70 oregon older. The U.S. Preventive Services Task Force went further, informing against aspirin for superior prevention starting astatine property 60.
Large objective trials had shown scant payment for aspirin arsenic a superior prevention measure, but determination were harms, notably gastrointestinal bleeding. “As we age, the risks of bleeding spell up,” said Timothy Anderson, an internist astatine the University of Pittsburgh who co-directs its Prescribing Wisely Lab. More rarely, but much seriously, aspirin tin origin bleeding successful the brain.
In a JAMA survey published past year, Anderson and his co-author recovered the connection was getting through: Aspirin usage for superior prevention, arsenic reported successful the National Health and Nutrition Examination Survey, had dropped substantially from 2011 to 2023. But much than a 3rd of those 70 oregon older were inactive taking it.
Some caveats: A subgroup of older adults with precocious hazard factors for cardiovascular illness mightiness payment from aspirin for superior prevention. And, confusingly, immoderate grounds suggests that older patients already taking aspirin look a higher hazard of cardiovascular illness if they discontinue it.
“Step 1 is simply a speech with your superior attraction physician,” Anderson said. “‘Is this inactive close for maine arsenic I get older?’”
Older patients taking aspirin, galore without immoderate aesculapian guidance, “are funny successful reducing their hazard of bosom onslaught and stroke,” helium said. “They’re trying to beryllium proactive and healthy.” But with humor unit medications and statins for cholesterol, “we person amended strategies than aspirin for that.”
KFF Health News is simply a nationalist newsroom that produces in-depth journalism astir wellness issues.
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