A recent qualitative study published in Frontiers in Pharmacology highlights the complexities surrounding benzodiazepine deprescription among older adults within primary healthcare settings. Researchers from the Universidade Federal de São João del-Rei in Brazil investigated the trajectory of benzodiazepine use, identifying key reasons for initiation and significant challenges encountered during attempts at discontinuation. The findings suggest that deprescription is a multifaceted process influenced by various biopsychosocial factors.
The Trajectory of Benzodiazepine Use
Benzodiazepines, first developed in 1955, became widely prescribed by 1990 for a range of conditions. While originally indicated for specific psychiatric and neurological disorders, their use expanded to encompass non-medical conditions such as stress, mild anxiety, and general ‘nervousness’. This expansion, described by the study authors as a process of medicalisation, has led to their widespread use, particularly in countries like Brazil, which ranks as the third-largest consumer globally despite regulatory measures.
Initiation and Medicalisation
The study found that older adults often initiated benzodiazepine use due to factors such as insomnia, significant life events, and work-related illness. For some, sleep-related issues, including nocturia (frequent nighttime urination), were cited as primary reasons for starting the medication. This pattern reinforces a medicalising logic where social and emotional experiences are often addressed through pharmacological intervention.
Risks for Older Adults
The chronic use of benzodiazepines is associated with several adverse effects, particularly concerning for older adults. These include:
- Anterograde amnesia
- Cognitive decline
- Daytime sleepiness
- Dependence and tolerance
- Increased risk of falls
Older adults are considered more susceptible to these effects due to metabolic and physiological adaptations, underscoring the importance of rational prescribing and careful consideration of the risk-benefit ratio for ongoing use.
Barriers to Benzodiazepine Deprescription
Despite the potential benefits of reducing or discontinuing benzodiazepines, the study revealed substantial biopsychosocial barriers that hinder successful deprescription. These challenges are not solely pharmacological but are deeply intertwined with patient experiences and healthcare system structures.
- Patient Expectations: Many participants expressed strong expectations regarding the medication’s effects, reinforcing continuity of use and making discontinuation difficult.
- Intolerance to Suffering: An aversion to experiencing discomfort or emotional distress, even mild, can deter individuals from attempting to reduce their dosage.
- Socioeconomic Limitations: Factors such as financial constraints or lack of social support can impact a patient’s ability to engage in deprescription efforts.
- Access to Alternatives: Unequal access to mental health services and a scarcity of non-pharmacological alternatives for managing conditions like insomnia or anxiety further complicate the process.
The researchers noted that prescriptions were often not clinically justified or were based on a merely medicalizing logic.
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