Interventions for reducing benzodiazepine use in older people: meta-analysis of randomised controlled trials

Rebecca L. Gould , Mark C. Coulson , Natasha Patel , Elizabeth Highton-Williamson , Robert J. Howard

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  • Declaration of interest

    None.

Abstract

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.

Footnotes

  • Funding

    This research was supported 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.

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