Journal of General Internal Medicine

, Volume 22, Issue 3, pp 303–307 | Cite as

Physicians’ Perspectives on Prescribing Benzodiazepines for Older Adults: A Qualitative Study

  • Joan M. Cook
  • Randall Marshall
  • Christina Masci
  • James C. Coyne
Original Article


There is a continued high prevalence of benzodiazepine use by older community-residing adults and of their continued prescription by practitioners, despite well known adverse effects and the availability of safer, effective alternatives.


To understand factors influencing chronic use of benzodiazepines in older adults.


Qualitative study, semistructured interviews with physicians.


Thirty-three practicing primary care physicians around Philadelphia.


Qualitative interviews were audiotaped, transcribed, and entered into a qualitative software program. A multidisciplinary team coded transcripts and developed themes.


Physicians generally endorsed benzodiazepines as effective treatment for anxiety, citing quick action and strong patient satisfaction. The use of benzodiazepines in older adults was not seen to be problematic because they did not show drug-seeking or escalating dose behavior suggesting addiction. Physicians minimized other risks of benzodiazepines and did not view monitoring or restricting renewal of prescriptions as an important clinical focus relative to higher-priority medical issues. Many physicians expressed skepticism about risks of continued use and considerable pessimism in the successful taper/discontinuation in older patients with long-term use and prior failed attempts. Physicians also anticipated patient resistance to any such efforts, including switching physicians.


Primary care physicians are averse to addressing the public health problem of benzodiazepine overuse in the elderly. Their attitudes generally conflict with practice guidelines and they complain of a lack of training in constructive strategies to address this problem. A 2-pronged effort should focus on increasing skill level and preventing new cases of benzodiazepine dependency through improved patient education and vigilant monitoring of prescription renewal.

Key words

geriatrics qualitative research benzodiazepines primary care physicians 


  1. 1.
    Hemmelgarn B, Suissa S, Huang A, Boivin JF, Pinard G. Benzodiazepine use and the risk of motor vehicle crash in the elderly. JAMA. 1997;278:27–31.PubMedCrossRefGoogle Scholar
  2. 2.
    Pomara N, Tun H, DaSilva D, Hernando R, Deptula D, Greenblatt DJ. The acute and chronic performance effects of alprazolam and lorazepam in the elderly: relationship to duration of treatment and self-rated sedation. Psychopharmacol Bull. 1998;34:139–53.PubMedGoogle Scholar
  3. 3.
    Ried LD, Johnson RE, Gettman DA. Benzodiazepine exposure and functional status in older people. J Am Geriatr Soc. 1998;46:71–6.PubMedGoogle Scholar
  4. 4.
    Wang PS, Bohn RL, Glynn RJ, Mogun H, Avorn J. Hazardous benzodiazepine regimens in the elderly: effects of half-life, dosage, and duration on risk of hip fracture. Am J Psychiatry. 2001;158:892–8.PubMedGoogle Scholar
  5. 5.
    Glass J, Lanctot KL, Herrmann N, Sproule BA, Busto UE. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ. 2005;331:1169–73.PubMedCrossRefGoogle Scholar
  6. 6.
    Stewart S. The effects of benzodiazepines on cognition. J Clin Psychiatry. 2005;66 (suppl 2):9–13.PubMedGoogle Scholar
  7. 7.
    American Psychiatric Association. Task Force on Benzodiazepine Dependency. Benzodiazepine dependence, toxicity, and abuse. Washington, DC: Author; 1990.Google Scholar
  8. 8.
    NIH Consensus Development Conference. Drugs and insomnia: the use of medications to promote sleep. JAMA. 1984;251:2410–14.CrossRefGoogle Scholar
  9. 9.
    Llorente MD, David S, Golden AG, Silverman MA. Defining patterns of benzodiazepine use in older adults. J Geriatr Psychiatry Neurol. 2000;13:150–60.PubMedGoogle Scholar
  10. 10.
    Gleason PP, Schulz R, Smith NL, et al. Correlates and prevalence of benzodiazepine use in community-dwelling elderly. J Gen Intern Med. 1998;13:243–50.PubMedCrossRefGoogle Scholar
  11. 11.
    Fialova D, Topinkova E, Gambassi G, et al. Potentially inappropriate medication use among elderly home care patients in Europe. JAMA. 2005;293:1348–58.PubMedCrossRefGoogle Scholar
  12. 12.
    Hanlon JT, Schmader KE, Boult C, et al. Use of inappropriate prescription drugs by older people. J Am Geriatr Soc. 2002;50:26–34.PubMedCrossRefGoogle Scholar
  13. 13.
    Miles M, Huberman A. (1994). Qualitative Data Analysis. Sage, London.Google Scholar
  14. 14.
    Nutting PA, Rost K, Dickinson M, et al. Barriers to initiating depression treatment in primary care practice. J Gen Intern Med. 2002;17:103–11.PubMedCrossRefGoogle Scholar
  15. 15.
    Forsetlund L, Talseth KO, Bradley P, Nordheim L, Bjorndal A. Many a slip between cup and lip: process evaluation of a program to promote and support evidence-based public health practice. Eval Rev. 2003;27:179–209.PubMedCrossRefGoogle Scholar
  16. 16.
    Heather N, Bowie A, Ashton H, et al. Randomised controlled trial of two brief interventions against long-term benzodiazepine use: outcome of intervention. Addict Res Theory. 2004;12:141–54.CrossRefGoogle Scholar
  17. 17.
    Cormack MA, Sweeney KG, Hughes-Jones H, et al. Evaluation of an easy, cost-effective strategy for cutting benzodiazepine use in general practice. Br J Gen Pract. 1994;44:5–8.PubMedGoogle Scholar
  18. 18.
    Bashir K, King M, Ashworth M. Controlled evaluation of brief intervention by general practitioners to reduce chronic use of benzodiazepines. Br J Gen Pract. 1994;44:408–12.PubMedGoogle Scholar
  19. 19.
    National Health Service Management Executive. The health of the nation: first steps for the NHS. Londong: NHSME, 1992.Google Scholar
  20. 20.
    Pimlott JG, Hux JE, Wilson LM, et al. Educating physicians to reduce benzodiazepine use by elderly patients: a randomized controlled trial. CMAJ. 2003;168:835–9.PubMedGoogle Scholar
  21. 21.
    Bambauer KZ, Sabin JE, Soumerai SB. The exclusion of benzodiazepine coverage in Medicare: simple steps for avoiding a public health crisis. Psychiatr Serv. 2005;56:1143–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Public Citizen Health Research Group. The risk of tranquility. Health Lett. 1985;1(4):5–6 (September/October).Google Scholar
  23. 23.
    Wolfe SM, Levin JD, Sobel P. Public Citizen Health Research Group. Testimony before the drug abuse advisory committee meeting. 1981, May 14.Google Scholar
  24. 24.
    Medicare Rights Center. Critical Coverage: Benzodiazepines under Medicare Part D. Washington, DC; Author:2005.Google Scholar

Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Joan M. Cook
    • 1
    • 2
  • Randall Marshall
    • 1
    • 2
  • Christina Masci
    • 3
  • James C. Coyne
    • 3
  1. 1.Columbia UniversityNew YorkUSA
  2. 2.New York State Psychiatric InstituteColumbia UniversityNew YorkUSA
  3. 3.University of PennsylvaniaPhiladelphiaUSA

Personalised recommendations