National trends in antidepressant, benzodiazepine, and other sedative-hypnotic treatment of older adults in psychiatric and primary care
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OBJECTIVE: To describe how use of antidepressants, benzodiazepines, and other anxiolytic/sedative-hypnotics among older adults (age ≥ 65 years) has changed over time among visits to primary care providers and psychiatrists. METHODS: Data were from the National Ambulatory Medical Care Survey (years 2003-2005 and 2010-2012), a nationally representative cross-section of outpatient physician visits. Analysis focused on visits to primary care providers (n = 14,282) and psychiatrists (n = 1,095) at which an antidepressant, benzodiazepine, or other anxiolytic/sedative-hypnotic was prescribed, which were stratified by demographic and clinical characteristic (including ICD-9-CM diagnosis) and compared across study intervals. Odds of medication use were calculated for each stratum, adjusting for demographic and clinical characteristics. RESULTS: The visit rate by older adults to primary care providers where any of the medications were prescribed rose from 16.4% to 21.8% (adjusted odds ratio [AOR] = 1.43, P < .001) while remaining steady among psychiatrists (75.4% vs 68.5%; AOR = 0.69, P = .11). Primary care visits rose for antidepressants (9.9% to 12.3%; AOR = 1.28, P = .01) and other anxiolytic/sedative-hypnotics (3.4% to 4.7%; AOR = 1.39, P = .01), but the largest growth was among benzodiazepines (5.6% to 8.7%; AOR = 1.62, P < .001). Among patients in primary care, increases primarily occurred among men, non-Hispanic white patients, and those with pain diagnoses as well as those with no mental health or pain diagnoses. CONCLUSIONS: From 2003 to 2012, use of the most common psychotropic medications among older adults seen in primary care increased, with concentration among patients with no mental health or pain diagnosis. As the population of older adults grows and receives mental health treatment in primary care, it is critical to examine the appropriateness of psychotropic use.
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While some studies have shown a decrease in the prescribing of some drug classes, such as benzodiazepines over time, these decreases have been small and inconsistent across different countries.
“While some studies have shown a decrease in the prescribing of some drug classes, such as benzodiazepines over time [83, 84], these decreases have been small and inconsistent across different countries [85, 86].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [86]
The Discussion reports that international findings on benzodiazepine prescribing were mixed, supporting the claim of inconsistency. It does not say that decreases were small; in this study of older US adults, benzodiazepine visits increased in primary care from 2003 to 2012. (LLM, conf=0.85)
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“While some studies have shown a decrease in the prescribing of some drug classes, such as benzodiazepines over time [83, 84], these decreases have been small and inconsistent across different countries [85, 86].”
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- Authors
- Maust, D. T., Blow, F. C., Wiechers, I. R., Kales, H. C., & Marcus, S. C.
- Affiliations
- University of Michigan (US)
- United States Department of Veterans Affairs (US)
- University of Pennsylvania (US)
- Corresponding author
- Maust, Donovan T.
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2017-04-26
- Volume
- 78
- Issue
- 04
- Pages
- e363-e371
- ISSN
- 0160-6689 (ISSN-L)
- PMC
- PMC5408458
- OpenAlex
- W2607739546
- Cited by
- 93
- References
- 57
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 14 · 2023: 6 · 2022: 8 · 2021: 13 · 2020: 11 · 2019: 13 · 2018: 16 · 2017: 2
- FWCI
- 6.94
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute on Aging (K08AG048321)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- antidepressants, benzodiazepines, older adults, primary care, psychiatrists, inappropriate medication use, National Ambulatory Medical Care Survey, medication appropriateness
- MeSH terms
- Aged, Aged, 80 and over, Antidepressive Agents, Benzodiazepines, Cross-Sectional Studies, Female, Humans, Hypnotics and Sedatives, Male, Primary Health Care, Psychiatry, United States, Health Care Surveys, Physicians, Primary Care
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