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

Background

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.

Objectives

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

Design

Qualitative study, semistructured interviews with physicians.

Participants

Thirty-three practicing primary care physicians around Philadelphia.

Approach

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

Results

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.

Conclusions

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 

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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

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