Interventions for Reducing Benzodiazepine Use in Older People: Meta-Analysis of Randomised Controlled Trials
Open accessAbstract
BACKGROUND: The use of benzodiazepines has been advised against in older people, but prevalence rates remain high. AIMS: To review the evidence for interventions aimed at reducing benzodiazepine use in older people. METHOD: We conducted a systematic review, assessment of risk of bias and meta-analyses of randomised controlled trials of benzodiazepine withdrawal and prescribing interventions. RESULTS: Ten withdrawal and eight prescribing studies met the inclusion criteria. At post-intervention, significantly higher odds of not using benzodiazepines were found with supervised withdrawal with psychotherapy (odds ratio (OR) = 5.06, 95% CI 2.68-9.57, P<0.00001) and withdrawal with prescribing interventions (OR = 1.43, 95% CI 1.02-2.02, P = 0.04) in comparison with the control interventions treatment as usual (TAU), education placebo, withdrawal with or without drug placebo, or psychotherapy alone. Significantly higher odds of not using benzodiazepines were also found for multifaceted prescribing interventions (OR = 1.37, 95% CI 1.10-1.72, P = 0.006) in comparison with control interventions (TAU and prescribing placebo). CONCLUSIONS: Supervised benzodiazepine withdrawal augmented with psychotherapy should be considered in older people, although pragmatic reasons may necessitate consideration of other strategies such as medication review.
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The last two meta-analyses on benzodiazepine withdrawal emphasise the effectiveness of supervised withdrawal supported by psychotherapy and in particular the addition of cognitive behavioral therapies.
“The last two meta-analyses on the topic [84,85] emphasise the effectiveness of supervised withdrawal supported by psychotherapy and in particular the addition of cognitive behavioral therapies.”
From Cognitive behavioral therapy and acceptance and commitment therapy for the discontinuation of long-term benzodiazepine use in insomnia and anxiety disorders (2021) · cites this paper as [85]
The Results and Discussion report that supervised withdrawal augmented with psychotherapy improved benzodiazepine discontinuation in older people compared with control interventions. The Withdrawal interventions section says CBT was used in two of the four psychotherapy studies, but the paper reports effectiveness for psychotherapy as a group, not a separate finding that CBT was particularly effective. (LLM, conf=0.85)
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- Authors
- Gould, R. L., Coulson, M. C., Patel, N., Highton-Williamson, E., & Howard, R. J.
- Affiliations
- King's College London (GB)
- Corresponding author
- Gould, Rebecca L.
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2014-02
- Volume
- 204
- Issue
- 2
- Pages
- 98-107
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W1999146743
- Cited by
- 156
- References
- 88
- Citations by year
- 2026: 8 · 2025: 9 · 2024: 10 · 2023: 2 · 2022: 11 · 2021: 12 · 2020: 11 · 2019: 16 · 2018: 27 · 2017: 11 · 2016: 17 · 2015: 13 · 2014: 9
- FWCI
- 1.44
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Middlesex University Research Repository (Middlesex University Of London) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- UEA Digital Repository (University of East Anglia) (submittedVersion)
- Funders
- King's College London
- King's Health Partners
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- benzodiazepines, older adults, benzodiazepine withdrawal, prescribing interventions, psychotherapy, medication review, polypharmacy
- MeSH terms
- Age Factors, Aged, Benzodiazepines, Combined Modality Therapy, Drug Administration Schedule, Drug Utilization, Humans, Placebos, Psychotherapy, Regression Analysis, Substance Withdrawal Syndrome, Anti-Anxiety Agents, Bias, Odds Ratio, Randomized Controlled Trials as Topic
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