Medical research often follows a predictable, methodical arc. Investigators scrutinize a widely prescribed medication, only to discover that it yields diminished benefits for older adults or carries risks that starkly outweigh its therapeutic value. Subsequent studies replicate these findings, validating the initial concerns. Eventually, medical associations update their clinical guidelines, urging physicians to avoid the drug or exercise far greater caution when prescribing it. The substance may find its way onto the Beers Criteria—the American Geriatrics Society’s influential compendium of potentially inappropriate medications for the elderly. When the drug serves a preventative purpose, the U.S. Preventive Services Task Force, an independent panel of national experts, issues formal cautions. Meanwhile, the Food and Drug Administration may mandate prominent "black box" warnings to highlight severe or life-threatening side effects.
Yet, years later, when researchers analyze sweeping national datasets to determine whether clinical practice has evolved and prescription rates have fallen, the answer is frequently disheartening. While utilization often declines, the drop is rarely sufficient. In many cases, prescription rates remain stubbornly stagnant or even climb upward.
"Medications are like barnacles," observed Dr. Michael Steinman, a geriatrician at the University of California, San Francisco, and co-director of the U.S. Deprescribing Research Network. "They’re easy to start, but they can be hard to stop."
This phenomenon, widely known in medical circles as clinical inertia, stems in part from the sheer volume of new information physicians must process daily. Clinicians juggle countless clinical updates, meaning critical warnings can take years to permeate everyday practice. However, experts note that clinical inertia is also deeply rooted in behavioral patterns. Doctors and patients alike grow accustomed to treating chronic conditions through established routines, making these approaches ingrained habits. Because finding alternative therapies requires effort and clinical navigation, defaulting to familiar treatments remains the path of least resistance.
Recent investigations into three distinct medications or drug classes heavily utilized by older Americans underscore the systemic scale of this challenge.
The Persisting Dangers of Benzodiazepines
Scientific warnings regarding benzodiazepines—commonly prescribed to treat insomnia and anxiety—have circulated within the medical community for more than two decades.
"They offer prompt relief," noted Dr. Mark Olfson, a psychiatrist and epidemiologist at Columbia University, explaining their enduring popularity among both patients and physicians.
The clinical trade-off, however, is severe. Benzodiazepines—including brand names such as Valium, Xanax, and Ativan, alongside related non-benzodiazepine "Z-drugs" like Ambien and Lunesta—substantially impair balance, physical coordination, and cognitive function. In older populations, these side effects frequently precipitate dangerous falls, bone fractures, and motor vehicle accidents. Furthermore, when patients simultaneously use opioids to manage chronic pain, the addition of benzodiazepines drastically increases the risk of fatal overdoses.
Compounding these physical risks is the addictive nature of the drugs.
"Once you’ve taken them for a period of time, you develop a dependence," Dr. Olfson explained. "When you come off them, you may develop withdrawal symptoms."
Examining recent national trends in a study published in the Annals of Internal Medicine, Dr. Olfson and his research team tracked progress in reducing prescription rates. Among adults aged 65 and older, the proportion filling a benzodiazepine prescription declined from approximately 14% in 2015 to 11.5% in 2024.
Despite this downward trend, the data reveals troubling caveats. The decline essentially stalled following the onset of the COVID-19 pandemic in 2020. Among patients aged 75 and older, prescribed usage actually ticked upward, moving from 12% in 2020 to roughly 13% four years later. Even more alarming, dispensing rates within long-term care facility pharmacies more than doubled during the study period, and approximately one-third of all users maintained their regimen for longer than six months, sharply amplifying their risk of physical dependence.
"It’s worrisome," Dr. Olfson stated, emphasizing that patients should never attempt to discontinue benzodiazepines abruptly or independently. Doing so can trigger severe withdrawal phenomena, necessitating a carefully monitored, multi-week tapering schedule supervised by a qualified medical professional.
Antibiotics and Diverticulitis: A Reluctance to Change Course
For decades, standard medical management for acute diverticulitis—the painful inflammation or infection of small outpouchings that develop in the colon wall—relied almost exclusively on broad-spectrum antibiotics, primarily fluoroquinolones like Cipro and Levaquin, or amoxicillin-clavulanate (Augmentin).
"It was unquestioned," recalled Dr. Jesse Sutton, a clinical pharmacist and researcher at the Minneapolis Veterans Affairs healthcare system. "Antibiotics are safe and effective, great, lifesaving drugs, so the mindset was: When in doubt, use them."
That paradigm shifted dramatically in 2015, when the American Gastroenterological Association issued formal clinical guidelines advising against the routine administration of antibiotics for "uncomplicated" diverticulitis, which accounts for the vast majority of cases. A succession of other prominent medical societies quickly followed suit.
Rigorous clinical trials had demonstrated that for uncomplicated cases, antibiotics exerted little to no measurable influence on patient mortality, the necessity for emergency surgery, overall complication rates, or disease recurrence.
"They hadn’t improved anything," Dr. Sutton noted.
Meanwhile, unnecessary antibiotic exposure carries substantial clinical downsides. Adverse drug reactions from antibiotics drive a significant volume of emergency department visits each year, manifesting as severe nausea, vomiting, and debilitating gastrointestinal distress. Furthermore, broad-spectrum antibiotic use elevates a patient’s vulnerability to Clostridioides difficile, a virulent and potentially lethal intestinal infection. On a societal level, the World Health Organization has designated antimicrobial resistance as a major global health threat, warning that indiscriminate usage steadily erodes the efficacy of frontline treatments.
Anticipating a gradual shift away from routine antibiotic use, Dr. Sutton and his colleagues analyzed treatment patterns across 70,000 patient visits spanning 120 Department of Veterans Affairs healthcare facilities over a ten-year period. Their findings, published in the Annals of Internal Medicine, surprised the research team: despite a decade of updated clinical guidelines, antibiotic prescriptions remained virtually universal, appearing in 97% of clinic visits for uncomplicated diverticulitis. Clinicians routinely deployed medications that offered no proven benefit, when patients likely would have achieved identical outcomes through a brief course of acetaminophen and a clear liquid diet.
This pattern of overuse extends far beyond diverticulitis, frequently manifesting in the management of asymptomatic bacteriuria—bacteria in the urine that cause no clinical symptoms—and upper respiratory infections that are viral in origin rather than bacterial.
"In such cases, when a doctor prescribes an antibiotic, I’d encourage patients to say, ‘Please explain the rationale for doing this,’" Dr. Sutton advised. "If they don’t, it’s OK to press pause."
The Evolving Consensus on Daily Aspirin
Unlike prescription pharmaceuticals, low-dose aspirin occupies a unique space in modern healthcare. Because it is inexpensive and available over the counter without a prescription, millions of older Americans independently initiate daily regimens under the assumption that it safeguards cardiovascular health.
For individuals who have already suffered a myocardial infarction, stroke, or undergone cardiac interventions such as stent placement or bypass surgery, secondary prevention with low-dose aspirin is firmly supported by clinical evidence, proving highly effective at lowering the probability of subsequent cardiovascular events.
However, the medical consensus surrounding primary prevention—administering aspirin to individuals with no prior history of cardiovascular disease—shifted significantly in 2019. That year, the American College of Cardiology and the American Heart Association jointly recommended against routine aspirin use for primary prevention in adults aged 70 and older. The U.S. Preventive Services Task Force adopted an even stricter stance, advising against primary prevention aspirin therapy for adults beginning at age 60.
Extensive clinical trials revealed minimal benefit for primary prevention, offset by tangible harms, most notably an increased risk of gastrointestinal bleeding.
"As we age, the risks of bleeding go up," explained Dr. Timothy Anderson, an internist at the University of Pittsburgh and co-director of the university’s Prescribing Wisely Lab. In rarer, more catastrophic cases, routine aspirin use can provoke intracranial hemorrhaging.
A study co-authored by Dr. Anderson and published in JAMA indicates that public health messaging is slowly breaking through. Data from the National Health and Nutrition Examination Survey demonstrated a substantial decline in primary prevention aspirin use between 2011 and 2023. Nevertheless, more than one-third of Americans aged 70 and older reported continued daily use.
Medical experts emphasize important nuances: a specific subset of older adults presenting with exceptionally high cardiovascular risk factors may still derive a net benefit from primary prevention aspirin. Conversely, emerging evidence suggests that discontinuing aspirin can occasionally trigger an acute spike in cardiovascular risk for patients who have taken it long-term, creating a complex clinical dilemma.
"Step 1 is a conversation with your primary care physician," Dr. Anderson recommended. "Is this still right for me as I get older?"
Many older adults who maintain self-directed aspirin regimens do so out of a genuine desire to be proactive about their health and longevity. Yet, as Dr. Anderson points out, modern medicine offers far more targeted and effective strategies for managing blood pressure and cholesterol. Navigating the transition away from outdated routines requires patience, open dialogue between clinicians and patients, and a shared commitment to modern, evidence-based care.
