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Older Patient Perspectives on Long-Term Anxiolytic Benzodiazepine Use and Discontinuation: A Qualitative Study

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Abstract

Objective

The objective of the study is to understand patient factors contributing to the chronicity of benzodiazepine use by older adults as a first step in the development of acceptable intervention strategies for taper/discontinuation or prevention of chronic use.

Design

The design of the study consists of qualitative semi-structured patient interviews.

Setting and participants

The participants were 50 anxiolytic benzodiazepine users, 61–95 years of age, recruited through referrals from primary care physicians who practiced in the general Philadelphia, Pennsylvania area.

Results

Many older chronic users have come to rely and psychologically depend on benzodiazepines for their unique soothing properties, attributing to these medications characteristics that extend beyond an ordinary medication, i.e., affording control over daily stress, bringing tranquility, and even prolonging life. Most of the patients denied or minimized side effects and expressed resistance to taper or discontinuation, ranging from subtle reluctance to outright refusal and fear of being left suffering without these medications.

Conclusions

The reluctance of older chronic benzodiazepine users to taper or discontinue use highlights the importance of prevention and early intervention strategies to avoid the development of chronic use. Suggestions for curbing chronic use are presented.

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Acknowledgments

This study was supported by two National Institute of Mental Health grants to Joan M. Cook, Ph.D. (R21 MH068565 “Use of Benzodiazepines by Older Primary Care Patients” and K01 MH070859 “Dissemination of Empirically Supported Psychotherapies”).

Conflict of Interest

None disclosed.

Details of Ethical Approval: This study had Institutional Review Board (IRB) approval from the University of Pennsylvania.

Author information

Authors and Affiliations

  1. New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, Unit #69, New York, NY, 10032, USA

    Joan M. Cook PhD & Tatyana Biyanova

  2. University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Christina Masci & James C. Coyne

Authors
  1. Joan M. Cook PhD
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  2. Tatyana Biyanova
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  3. Christina Masci
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  4. James C. Coyne
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Corresponding author

Correspondence to Joan M. Cook PhD.

APPENDIX

APPENDIX

Semi-Structured Qualitative Patient Interview Guide

I want to thank you for agreeing to answer some questions for our project. We are very interested in knowing your ideas and opinions on medications. Of course, there are no right or wrong answers.

Can you please tell me the names of the medications you are taking?

Here is a medicine (the benzodiazepine) that you are taking...

What is it for?

What does it do for you?

How does it affect you?

How do you feel about taking it?

How do you feel if you don’t take it?

Are there any problems that can be caused by this medication?

Do you remember when your doctor first prescribed it for you?

Can you tell me about that?

Important to do all probes: How did it come up? Who initiated conversation? What was discussed (i.e., purpose of medicine, side effects, how much and how long to take)?

Why do you think your doctor first suggested this medication to you?

If you think back to when you first started taking it, do you have a sense for how long you thought you’d be taking it?

What does your current doctor (if different than one who started them) think about you taking the medicine now?

What does your family think about you taking it?

Does taking/not taking this medication interfere with your day? With your night?

Does taking/not taking this medication affect your relationships with your family? How so?

How do you get more of this medication?

Have you ever by mistake or on purpose not taken the medicine? If so, what happened?

Have you ever changed the dose of the medicine?

If yes: How and why did that happen? Did you notice any difference?

What do you think would happen if you stopped taking the medicine completely?

Have you ever thought of other ways to deal with this issue?

If so, what? What happened if you tried?

Have you ever talked to anyone about this issue? (i.e. Spouse? Friend? Family member? Priest/minister? Counselor?)

These medicines have sometimes been used for sleep problems, anxiety, stress, and depression. Are any of these problems for you?

How does the medication affect these problems? (e.g., cure, symptom relief, no impact)

What if your physician mentioned other ways to deal with this issue?

Probe: Such as some kind of counseling? How would you feel about that? Would you be willing to try that?

If there were ways of reducing your use of the medication, would you be interested in hearing about them?

How much time and effort would you put into reducing your use of this medication if the chance were offered to you?

Are there things about your medication that you would like to tell me about that we haven’t talked about? If yes, what are some examples?

Thank you so much for talking with me today.

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Cook, J.M., Biyanova, T., Masci, C. et al. Older Patient Perspectives on Long-Term Anxiolytic Benzodiazepine Use and Discontinuation: A Qualitative Study. J GEN INTERN MED 22, 1094–1100 (2007). https://doi.org/10.1007/s11606-007-0205-5

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  • DOI: https://doi.org/10.1007/s11606-007-0205-5

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