title: No End in Sight: Benzodiazepine Use in Older Adults in the United States.
abstract: To establish the rate of new and continuation of benzodiazepine use in older adults seen by nonpsychiatrist physicians and to identify subpopulations at risk of new and continuation benzodiazepine use.
  
  
  
  Cross-sectional analysis.
  
  
  
  National Ambulatory Medical Care Survey (2007-10).
  
  
  
  Adults visiting office-based nonpsychiatrist physicians (n = 98,818) who were prescribed a benzodiazepine (new or continuation).
  
  
  
  Percentage of benzodiazepine visits of all outpatient encounters according to patient age and corresponding annual visit rate per 1,000 population. Analysis was then limited to adults aged 65 and older, demographic, clinical, and visits characteristics were used to compare visits of benzodiazepine users with those of nonusers and visits of continuation users with those of new users.
  
  
  
  The overall proportion of benzodiazepine visits ranged from 3.2% (95% confidence interval (CI) = 2.7-3.7) of those aged 18 to 34 to 6.6% (95% CI = 5.8-7.6) of those aged 80 and older, and the proportion of continuation visits increased with age, rising to 90.2% (95% CI = 86.2-93.1) of those aged 80 and older. The population-based visit rate ranged from 61.7 (95% CI = 50.7-72.7) per 1,000 persons in the youngest adults to 463.7 (95% CI = 385.4-542.0) in those aged 80 and older. Only 16.0% (95% CI = 13.5-18.8) of continuation users had any mental health diagnosis. Of all benzodiazepine users, fewer than 1% (95% CI = .4-1.8) were provided or referred to psychotherapy, and 10.0% (95% CI = 7. 2-13.3) were also prescribed an opioid.
  
  
  
  In the United States, few older adult benzodiazepine users receive a clinical mental health diagnosis, and almost none are provided or referred to psychotherapy. Prescribing to older adults continues despite decades of evidence documenting safety concerns, effective alternative treatments, and effective methods for tapering even chronic users.
authors.affiliation: Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.|Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.|Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
authors.forename: Donovan T
authors.initials: DT
authors.lastname: Maust
authors.affiliation: Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.|Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.|Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
authors.forename: Helen C
authors.initials: HC
authors.lastname: Kales
authors.affiliation: Northeast Program Evaluation Center, Office of Mental Health Operations, U.S. Department of Veterans Affairs, West Haven, Connecticut.|Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut.
authors.forename: Ilse R
authors.initials: IR
authors.lastname: Wiechers
authors.affiliation: Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.|Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.|Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
authors.forename: Frederic C
authors.initials: FC
authors.lastname: Blow
authors.affiliation: Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York.|New York State Psychiatric Institute, New York, New York.
authors.forename: Mark
authors.initials: M
authors.lastname: Olfson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001569:Benzodiazepines / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014481:United States
chemical_list: D001569:Benzodiazepines
keywords: anxiety; benzodiazepine; insomnia; psychotropic