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Older adults can reduce their benzodiazepine use if they receive withdrawal support in combination with psychotherapy

Gould RL, Coulson MC, Patel N, et al.  Interventions for reducing benzodiazepine use in older people: Meta-analysis of randomised controlled trials The British Journal of Psychiatry. 2014;204(2):98-107.

Review question

What interventions are effective for reducing benzodiazepine (e.g. anti-anxiety medication) use in older people?

Background

Long-term use of benzodiazepines is advised against in older adults, given it may lead to cognitive impairment, increased falls and fractures, traffic accidents, delirium and increased dependence on caregivers.

Despite recommendations, benzodiazepine use is high among older adults, and has been attributed to lack of knowledge among healthcare providers in geriatric care settings, difficulties in ensuring prescribing guidelines are followed, and psychological and physiological dependence among older adults who have been prescribed these drugs.

Interventions to reduce benzodiazepine use by helping patients withdraw from using them, as well as by changing prescribing behaviour, have shown promise.

How the review was done

Several electronic databases were searched for research conducted up to October 2012, and studies were included if they focused on interventions aimed at reducing benzodiazepine use among older adults (with no participants younger than 50 years old).

Searches identified 2,848 studies, and the authors included 16 that focused on interventions to support withdrawal from benzodiazepines, changing health professionals’ prescribing practices, or both.

The review was funded by the Mental Health of Older Adults and Dementia Clinical Academic Group within King’s Health Partners Academic Health Sciences Centre at the Institute of Psychiatry, King’s College London, and the South London and Maudsley National Health Service Foundation Trust.

What the researchers found

Supervised withdrawal support with psychotherapy was found to help reduce benzodiazepine use among older adults, although it may not continue to be effective in the medium and long term.

The evidence is not clear about whether withdrawal support in combination with interventions focused on changing prescribing behaviour, or other pharmacotherapy, are effective.

Interventions with several components that focus on changing prescribing behaviour are effective, but may not lead to big changes in benzodiazepine use.

Conclusion

Older adults are more likely to stop using benzodiazepines if they are supervised and supported through a withdrawal schedule augmented with psychotherapy.

Limited evidence suggests that a withdrawal schedule in combination with both patient and healthcare-provider education are helpful in reducing  benzodiazepine use, and may be more practical when access to psychotherapy is limited.

This summary is based on a review that was determined to be of medium methodological quality based on an assessment using the AMSTAR tool.