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Drugs & Aging

, Volume 35, Issue 6, pp 493–521 | Cite as

Deprescribing Benzodiazepines in Older Patients: Impact of Interventions Targeting Physicians, Pharmacists, and Patients

  • Brendan J. Ng
  • David G. Le Couteur
  • Sarah N. Hilmer
Review Article

Abstract

Benzodiazepines (BZDs; including the related Z-drugs) are frequently targets for deprescribing; long-term use in older people is harmful and often not beneficial. BZDs can result in significant harms, including falls, fractures, cognitive impairment, car crashes and a significant financial and legal burden to society. Deprescribing BZDs is problematic due to a complex interaction of drug, patient, physician and systematic barriers, including concern about a potentially distressing but rarely fatal withdrawal syndrome. Multiple studies have trialled interventions to deprescribe BZDs in older people and are discussed in this narrative review. Reported success rates of deprescribing BZD interventions range between 27 and 80%, and this variability can be attributed to heterogeneity of methodological approaches and limited generalisability to cognitively impaired patients. Interventions targeting the patient and/or carer include raising awareness (direct-to-consumer education, minimal interventions, and ‘one-off’ geriatrician counselling) and resourcing the patient (gradual dose reduction [GDR] with or without cognitive behavioural therapy, teaching relaxation techniques, and sleep hygiene). These are effective if the patient is motivated to cease and is not significantly cognitively impaired. Interventions targeted to physicians include prescribing interventions by audit, algorithm or medication review, and providing supervised GDR in combination with medication substitution. Pharmacists have less frequently been the targets for studies, but have key roles in several multifaceted interventions. Interventions are evaluated according to the Behaviour Change Wheel. Research supports trialling a stepwise approach in the cognitively intact older person, but having a low threshold to use less-consultative methods in patients with dementia. Several resources are available to support deprescribing of BZDs in clinical practice, including online protocols.

Notes

Compliance with Ethical Standards

Funding

BN is supported by scholarships funded by the Ageing and Alzheimers Institute, Concord Hospital, the Penney Ageing Research Unit, Royal North Shore Hospital, and the Australia New Zealand Society for Geriatric Medicine. SH and DLC are investigators on a related research project, ‘Reducing Inappropriate Polypharmacy in Older Inpatients’, which is funded by the New South Wales Health Translational Research Grants Scheme, grant TRG274. Role of the Funder/Sponsor The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Conflict of interest

Brendan Ng, David Le Couteur and Sarah Hilmer declare that they have no conflicts of interest directly relevant to the content of this article.

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Faculty of MedicineUniversity of SydneySydneyAustralia
  2. 2.Departments of Aged Care and Clinical PharmacologyKolling Institute, Royal North Shore HospitalSt LeonardsAustralia
  3. 3.Ageing and Alzheimers Institute, Concord HospitalConcordAustralia

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