The lag between research and practice

Medical researchers find a drug is risky or ineffective for older patients. Guidelines change. But years later, doctors still prescribe it at nearly the same rates.

Why change happens slowly

Medications are like barnacles, says a geriatrician at UCSF. They're easy to start but hard to stop. Clinicians get used to treating conditions certain ways, and those habits become ingrained.

“Medications are like barnacles. They're easy to start, but they can be hard to stop.”

Information takes time to spread

Clinicians have countless things to learn and attend to. New findings about drug risks take years to reach doctors in practice, slowing adoption of safer approaches.

Benzodiazepines: the 20-year warning

Scientists have warned about benzodiazepines like Valium and Xanax for over 20 years. They're prescribed for insomnia and anxiety but carry serious risks for older adults.

How benzos harm older patients

Benzodiazepines impair balance, coordination, and thinking, leading to falls, fractures, and car accidents. Combined with opioids, they can cause overdoses. They also create dependence.

Benzo use among older adults

From 2015 to 2024, prescriptions for benzodiazepines dropped from 14 percent to 11.5 percent among people 65 and older. But the decline has stalled since 2020.

Benzos rising in the oldest adults

Among people over 75, benzo use actually increased from 12 percent in 2020 to about 13 percent four years later. Long-term care facilities more than doubled their dispensing.

“It's worrisome.”

Stopping benzos requires medical help

Patients shouldn't stop benzodiazepines suddenly on their own, which can cause dangerous withdrawal. It requires supervised tapering with a doctor over many weeks.

Antibiotics for diverticulitis

For years, antibiotics were the standard treatment for diverticulitis, inflammation of colon pouches. In 2015, medical groups recommended against them for uncomplicated cases.

Antibiotics don't help uncomplicated cases

Clinical trials showed antibiotics had little or no effect on death rates, surgery needs, complications, or recurrences for uncomplicated diverticulitis. They hadn't improved anything.

Antibiotics carry real risks

Antibiotic side effects cause substantial emergency room visits for nausea, vomiting, and diarrhea. They increase risk of dangerous C. difficile infection and fuel antimicrobial resistance.

Antibiotics still prescribed 97 percent of the time

A study of 70,000 visits to 120 VA facilities found antibiotic prescriptions remained nearly universal at 97 percent for uncomplicated diverticulitis, despite new guidelines.

What patients could take instead

For uncomplicated diverticulitis, patients would most likely do as well with a few days of Tylenol and a clear liquid diet, avoiding antibiotics altogether.

Ask your doctor about antibiotics

When prescribed an antibiotic, ask your doctor to explain the rationale. If they don't provide one, it's okay to press pause and seek a second opinion.

Aspirin for heart health

Millions of older Americans take aspirin over the counter, thinking it prevents heart problems. For people who've had a heart attack or stroke, daily low-dose aspirin does help.

Guidelines changed on aspirin prevention

In 2019, the American College of Cardiology and American Heart Association recommended against aspirin for primary prevention in people 70 or older. The Preventive Services Task Force warned against it starting at age 60.

Aspirin's risks outweigh benefits

Large clinical trials showed aspirin provides little benefit for primary prevention but carries real harms, notably gastrointestinal bleeding. As we age, bleeding risks increase.

Aspirin use is declining but not fast enough

From 2011 to 2023, aspirin use for primary prevention dropped substantially among older adults. But more than a third of those 70 or older were still taking it.

Talk to your doctor about aspirin

Have a conversation with your primary care physician about whether aspirin is still right for you as you age. Better strategies like blood pressure medications and statins exist.

“Step 1 is a conversation with your primary care physician about aspirin. 'Is this still right for me as I get older?'”