Recent research highlights the persistent overuse of several common medications among older adults, despite growing evidence that their risks often outweigh their benefits in this population. Three widely used drug categories—benzodiazepines, antibiotics for uncomplicated diverticulitis, and aspirin for primary prevention of cardiovascular disease—illustrate ongoing challenges in aligning prescribing practices with updated clinical guidelines.

Benzodiazepines, prescribed for anxiety and insomnia, have been flagged for more than two decades due to their potential to impair balance, cognition, and coordination in older patients, increasing the likelihood of falls, fractures, and accidents. Additionally, concurrent use with opioids raises the risk of overdose, and extended consumption can lead to physical dependence and withdrawal symptoms. A recent analysis covering 2015 to 2024 showed a modest decline in benzodiazepine use among those over 65, dropping from 14 percent to 11.5 percent. However, use increased among those older than 75 during the COVID-19 pandemic period, rising from 12 percent in 2020 to 13 percent by 2024. The proportion of long-term users—those taking the drugs for more than six months—remains significant, raising concerns among experts. Medical professionals emphasize the importance of supervised tapering to avoid withdrawal when discontinuing these medications.

Antibiotic prescriptions for uncomplicated diverticulitis represent another area of concern. Historically, antibiotics such as fluoroquinolones and amoxicillin-clavulanate were routinely administered for this condition. However, since 2015, leading gastroenterological associations have advised against their routine use for uncomplicated cases, citing clinical trials that found no significant impact on mortality, surgical intervention rates, or disease recurrence. Despite these recommendations and the well-documented risks of antibiotic overuse—including side effects and the promotion of antimicrobial resistance—studies examining over 70,000 patient visits to Veterans Affairs facilities indicate that antibiotics remain prescribed in nearly 97 percent of uncomplicated diverticulitis cases. This trend extends to other conditions frequently encountered in older adults, such as asymptomatic urinary tract infections and viral upper respiratory infections, where antibiotic use is often inappropriate.

Aspirin use for primary prevention of cardiovascular events in older adults also reveals a gap between evidence and practice. While aspirin remains beneficial for secondary prevention in patients with a history of heart attack, stroke, or cardiac procedures, guidelines since 2019 have recommended against its use for primary prevention in individuals aged 70 and older. The U.S. Preventive Services Task Force advises caution even starting at age 60, due to increased risks of gastrointestinal and intracranial bleeding associated with aspirin in older patients. Data from national surveys reveal a notable reduction in aspirin use for primary prevention between 2011 and 2023, though more than one-third of adults 70 or older continue to take it. Experts suggest that certain high-risk individuals may still benefit from aspirin, but stress the need for personalized discussions between patients and their healthcare providers to evaluate ongoing aspirin therapy.

These examples underscore the challenge of changing longstanding prescribing habits in clinical practice, where both physicians and patients may rely on familiar treatments despite new evidence. Efforts to promote deprescribing and encourage alternative management strategies are vital to reducing medication-related risks in the aging population.