Discontinuing Benzodiazepine Therapy: An Interdisciplinary Approach at a Geriatric Day Hospital

Abstract

The overuse of benzodiazepines is a commonly recognized problem among elderly patients. Between 22% and 27% of adults over age 65 use benzodiazepines regularly. 1,2 This rate rises to over 30% among those above age 85. 2,3 Up to 50% of people taking benzodiazepines do so over the long term, sometimes for decades. 4 This practice is contradictory to evidence showing that benzodiazepines are effective for treatment of insomnia only for short periods (up to 6 weeks). 5,6 Health Canada has recommended that benzodiazepine treatment for anxiety not exceed 2 months, including the tapering-off period. [7][8][9]

The Barriers and Facilitators of Different Stakeholders When Deprescribing Benzodiazepine Receptor Agonists in Older Patients—A Systematic Review

“…Finding the BZRA treatment effective was a barrier shared between patients, physicians, and nurses [ 16 , 17 , 19 , 20 , 22 ]. Likewise, some patients and nurses believe that the BZRA treatment provides the patient with a feeling of comfort, creating a view of continued use as being necessary [ 8 , 15 , 16 , 22 ].…”

“…Several stakeholders can be involved in deprescribing BZRA in older patients such as healthcare personnel and patients [ 4 , 8 ]. To our knowledge, no systematic review exists with the main focus of exploring and comparing the barriers and facilitators of stakeholders towards deprescribing BZRA in older patients.…”

Uncovering the source of new benzodiazepine prescriptions in community‐dwelling older adults’

“…Despite their association with adverse events, prescriptions for benzodiazepines continue to be dispensed to as many as 30% of older adults, often chronically over many years (Shan et al, 1990;Tamblyn et al, 1994;Egan et al, 2000;Barnard et al, 2001;Elliott et al, 2001;Hanlon et al, 2001;van Hulten et al, 2003;Balestrieri et al, 2005;Peterson et al, 2005;Nurmi-Lüthje et al, 2006;Simon and Ludman, 2006;Beland et al, 2010;Voyer et al, 2010). Interventions targeting pharmacists (Hanlon et al, 1996;Blakey and Hixson-Wallace, 2000;Tolwe and Adams, 2006;Nishtala et al, 2008;Chen et al, 2010) and physicians with educational material to discontinue benzodiazepine prescriptions have yielded variable results, with discontinuation rates as high as 19% (Dollman et al, 2005) and as low as 0.7% (Pimlott et al, 2003). Reasons for the failure to reduce benzodiazepine use relate to perceptions of the issue not being a clinical priority, minimization of benzodiazepine-associated adverse effects, anticipation of withdrawal failure, and patient resistance together with time and reimbursement barriers (Cook et al, 2007).…”

Managing chronic diseases in the frail elderly

“…Our usual approach to managing benzodiazepine tapering is published elsewhere. 14 While tolterodine can also contribute to fall risk through its anticholinergic effect, it was felt that continued use at his stable and effective dose was justified for this patient, since rushing to the bathroom had previously been a problem and could increase fall risk.…”