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Physicians’ Perspectives on Prescribing Benzodiazepines for Older Adults: A Qualitative Study
Open accessAbstract
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.
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“The most frequent indications for psychotropic prescribing were depression in nine studies [50, 51, 55, 56, 60, 62, 73, 74, 82], sleeping disorders in seven [54–56, 59, 63, 74, 82] and anxiety in six [54–56, 73, 74, 82].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [54]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“older patients expressed the view that they did not wish to ‘experiment’ at their age by tapering or discontinuing their psychotropic medication [54–56, 59].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [54]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Doctors anticipated resistance to discontinuation of psychotropic medication or introduction of non-pharmacological interventions”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [54]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“However, side effects associated with psychotropic medication were also minimised by some older people, doctors and family members [54–56, 59, 63, 65, 74, 81, 82].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [54]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Doctors and nurses were of the view that assessing whether psychotropic medication was appropriate in older people was challenging [49, 53–56, 62, 65, 80–82].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [54]
Experimental — accuracy not yet measured
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In the citing paper
“Addressing psychotropic use was considered difficult and time-consuming by doctors, with psychotropic discontinuation requiring more time than other medication [54, 56, 57, 59].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [54]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“These included lack of time, training, funding, accessibility, volunteers or other resources [53, 54, 56, 59, 65, 81], and older people not wishing to try psychological interventions [54–56].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [54]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“However, some doctors criticized guidelines as being ‘out of touch’ with real-world problems and practice and discussed how over-regulation of psychotropic medication did not necessarily improve care [53, 54, 81].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [54]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Where older people rejected interventions such as bereavement counselling, doctors expressed a lack of alternatives [54–56, 80].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [54]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Doctors indicated that they did not necessarily agree with or promote long-term use in; however, they discussed being more tolerant of long-term use in older people [54, 56, 59].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [54]
The cited source says what the claim attributes to it.
In the citing paper
“Negative effects experienced by patients during prior attempts to discontinue were also reported to discourage further attempts [54–56, 74].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [54]
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“Many doctors referred to the process of a risk–benefit analysis [53–56, 59, 65, 82].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [54]
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“Some doctors were also of the view that older people had a low potential for abuse and minimised or accepted the risks of addiction [54, 59, 74, 82].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [54]
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Metadata
- Authors
- Cook, J. M., Marshall, R., Masci, C., & Coyne, J. C.
- Affiliations
- Columbia University (US)
- New York State Psychiatric Institute (US)
- University of Pennsylvania (US)
- Corresponding author
- Cook, Joan M.
- ORCID
- Cook, Joan M.
- Venue
- Journal of General Internal Medicine
- Published
- 2007-01-25
- Volume
- 22
- Issue
- 3
- Pages
- 303-307
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC1824720
- OpenAlex
- W1972782221
- Cited by
- 178
- References
- 23
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 7 · 2023: 9 · 2022: 10 · 2021: 7 · 2020: 11 · 2019: 9 · 2018: 16 · 2017: 13 · 2016: 7 · 2015: 12 · 2014: 14 · 2013: 7 · 2012: 11
- FWCI
- 4.35
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (R21MH068565, K01MH070859)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- benzodiazepines, older adults, chronic benzodiazepine use, benzodiazepine overuse, benzodiazepine tapering, benzodiazepine discontinuation, anxiety treatment, physician training, primary care
- MeSH terms
- Age Factors, Aged, Attitude of Health Personnel, Benzodiazepines, Family Practice, Female, Humans, Interviews as Topic, Male, Middle Aged, Patient Education as Topic, Physicians, Drug Prescriptions, Substance-Related Disorders
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