Three medications that fill millions of American medicine cabinets have been quietly downgraded for older adults in the last decade, but prescribing habits have been slow to catch up.
Benzodiazepines for sleep and anxiety, antibiotics for uncomplicated diverticulitis, and daily low-dose aspirin for heart-attack prevention are all under renewed scrutiny in adults over 60, based on newer trials and updated guidelines.
Recent research shows the gap between what guidelines recommend and what patients actually receive is still wide.
A retrospective cohort study of Veterans Affairs facilities published in Annals of Internal Medicine on June 23, 2026, found antibiotics were prescribed in 96.6 percent of outpatient visits for uncomplicated diverticulitis over a ten-year window.
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A separate national analysis of benzodiazepine prescribing in the same journal in July found progress on cutting these drugs in older adults has stalled since 2020.
Benzodiazepines for sleep and anxiety
Drugs like alprazolam (Xanax), lorazepam (Ativan), and diazepam (Valium), collectively called benzodiazepines, can impair balance, coordination, and thinking. In older adults, that means a higher risk of falls, fractures, and car crashes.
Prescriptions to Americans 65 and older fell from 14.1 fills per 100 people in 2015 to 11.5 in 2024, according to the Columbia University-led analysis.
The catch: the drop happened before the pandemic, and rates have plateaued since 2020. Use actually went up among people 75 and older and among those in long-term care.
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"Our findings suggest that the COVID-19 pandemic may have disrupted progress in reducing benzodiazepine use among older adults," Mark Olfson, professor of psychiatry at Columbia University, said in the university's statement. "This is concerning because older adults are especially vulnerable to the medications' adverse effects."
Stopping benzodiazepines abruptly can trigger withdrawal, so any change should be handled by a doctor, usually as a slow taper over weeks.
Antibiotics for uncomplicated diverticulitis
For decades, an inflamed pouch in the colon meant a course of antibiotics. Then trials found antibiotics did not meaningfully lower the risk of complications, surgery, or recurrence in patients with the milder, uncomplicated form.
In 2015 the American Gastroenterological Association shifted its guidance and recommended that antibiotics be used selectively rather than routinely in acute uncomplicated diverticulitis.
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The 2026 VA analysis of 33,634 visits at 116 facilities found the guidance made little difference in practice.
Antibiotics still come with real downsides in older patients. Those include a higher risk of Clostridioides difficile infection, a serious intestinal illness, and side effects that drive emergency-room visits.
Daily aspirin for heart attack prevention
For people who have already had a heart attack or stroke, daily low-dose aspirin remains standard. For older adults who have never had one, the calculus has changed.
The U.S. Preventive Services Task Force issued a "D" recommendation in April 2022 against starting low-dose aspirin for primary prevention of cardiovascular disease in adults 60 and older.
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The 2019 primary-prevention guideline from the American College of Cardiology and the American Heart Association had already advised against routine aspirin for adults over 70.
The reason is bleeding. The risk of gastrointestinal bleeding, and rarely brain bleeding, rises with age and can cancel out any benefit.
The task force's guidance is for people considering starting aspirin. If you are already taking it, do not stop on your own. Talk to your doctor first, especially if you have a history of heart disease, stents, or stroke.
Bring the full list, including over-the-counter pills and supplements, to the next primary-care visit and ask which ones still fit your age and health today.
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This article is made and published by Mie Hermansen, who may have used AI in the preparation.