Interventions to improve benzodiazepine tapering success in the elderly: a systematic review

ABSTRACT

Background: Long-term benzodiazepine use in the elderly population is a significant public health problem that leads to impaired cognitive functioning, medication dependence and increased risks for adverse drug reactions. The aim of this review was to examine randomized controlled trials (RCTs) on the efficacy of different methods for tapering and discontinuing benzodiazepines.

Method: We used four databases (Ovid, PubMed, Academic Search Complete, Web of Science) to retrieve randomized controlled trials published in peer-reviewed journals that explored different methods for tapering benzodiazepine use in a primarily geriatric population.

Results: Eleven papers met the inclusion criteria. Methods to assist in benzodiazepine tapering included patient education, cognitive behavioural therapy (CBT), and pharmaceutical adjuvants (SSRIs, melatonin, progesterone). Patient education was consistently effective in increasing benzodiazepine discontinuation success while CBT had mixed but promising results. The use of medications to help improve tapering success was inconclusive.

Conclusions: Patient education is a successful, time- and cost-effective intervention that can significantly help with benzodiazepine discontinuation success. CBT may also be an effective approach. However, cost can be an issue since public healthcare coverage in Canada does not cover psychotherapy. More research is needed in looking at pharmaceutical adjuvants and their role in assisting with benzodiazepine discontinuation.

KEYWORDS:

• Elderly
• senior
• benzodiazepine
• tapering
• discontinuation
• review
• CBT
• cognitive behavioural therapy
• patient education
• SSRIs
• melatonin
• progesterone

Disclosure statement

No potential conflict of interest was reported by the authors.