Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Mar 3;8(3):e2459883.
doi: 10.1001/jamanetworkopen.2024.59883.

Barriers to Deprescribing Benzodiazepines in Older Adults in a Survey of European Physicians

Vladyslav Shapoval  1 , Marie de Saint Hubert  2   3 , Perrine Evrard  1 , François-Xavier Sibille  1   2   3 , Carole E Aubert  4   5 , Lucy Bolt  4   5 , Vagioula Tsoutsi  6 , Pinelopi Kollia  6 , Antoni Salvà  7 , Ramon Miralles  8 , Adam Wichniak  9   10 , Katarzyna Gustavsson  9   11 , Torgeir Bruun Wyller  12   13 , Enrico Callegari  12   14 , Jeremy M Grimshaw  15   16 , Justin Presseau  15   17 , Séverine Henrard  1   3 , Anne Spinewine  1   18
Affiliations

Barriers to Deprescribing Benzodiazepines in Older Adults in a Survey of European Physicians

Vladyslav Shapoval et al. JAMA Netw Open. .

Abstract

Importance: The use of benzodiazepine receptor agonists (BZRA) poses serious health risks to older adults. Although several guidelines recommend deprescribing, implementation in clinical practice remains limited.

Objective: To identify physicians' barriers to and enablers of deprescribing BZRA in adults aged 65 years and older taking a BZRA for sleep problems; to determine factors associated with hospital physicians' intention to deprescribe BZRA and their self-reported routine BZRA deprescribing.

Design, setting, and participants: This survey study included hospital physicians and general practitioners (GPs) working across 6 European Countries (Belgium, Greece, Norway, Poland, Spain, and Switzerland) between December 2022 and March 2023.

Main outcomes and measures: Barriers identification via a 35-item questionnaire based upon the Theoretical Domains Framework (TDF). Responses were categorized as major barriers, moderate barriers, and enablers based on their mean scores. Multivariable logistic regressions were used to identify background characteristics and TDF-based domains associated with hospital physicians' intention to deprescribe and self-reported routine deprescribing.

Results: Questionnaires from 240 hospital physicians and 96 GPs were analyzed. Most participants were women: 144 (61.0%) hospital physicians and 52 (54.2%) GPs. In terms of experience, the most common reported time in practice was less than 5 years for hospital physicians (76 [31.7%]) and between 10 and 14 years for GPs (35 [36.5%]). Most reported deprescribing BZRA routinely (135 hospital physicians [57.2%] and 66 GPs [72.5%]). Major barriers (and TDF domains) were similar for hospital physicians and GPs across the 6 countries. These barriers included: lack of training (skills), low self-efficacy (beliefs about capabilities), prioritization of other health issues (goals), frustration with the challenges of deprescribing (emotions), insufficient staff and time, absence of local policies (environmental context and resources), and reluctance from patients (social influence). Intention to deprescribe was significantly associated with country, occupation type, and 5 TDF domains: memory, attention, and decision process (odds ratio [OR], 1.70; 95% Ci, 1.22-2.40); social and/or professional role and identity (OR, 5.92; 95% CI, 3.28-11.07); beliefs about capabilities (OR, 2.35; 95% CI, 1.55-3.63); beliefs about consequences (OR, 3.00; 95% CI, 1.61-5.71); and reinforcement (OR, 1.49; 95% CI, 1.05-2.15). Routine deprescribing was significantly associated with 3 TDF domains: memory, attention, and decision processes; intentions; and emotions.

Conclusion: In this theory-based survey study of physicians, physicians and general practitioners described numerous barriers to deprescribing BZRA in older adults. Our findings indicate that effective deprescribing efforts require approaches that address both reflective processes (eg, enhancing capability) and impulsive processes (eg, managing emotions).

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Shapoval reported grants from UCLouvain Horizon Europe (grant No. 10105712) during the conduct of the study. Dr de Saint-Hubert reported grants from UCLouvain Horizon Europe (grant No. 10105712) during the conduct of the study. Dr Sibille reported grants from the National Fund for Scientific Research (FNRS) during the conduct of the study. Dr Aubert reported grants from Staatssekretariat für Bildung, Forschung und Innovation, Kollegium für Hausarzt Medizin during the conduct of the study; she reported grants from Swiss National Foundation outside the submitted work. Dr Bolt reported grants from Kollegium für Hausarztmedizin during the conduct of the study. Dr Gustavsson reported personal fees from Przedsiębiorstwo Farmaceutyczne LEK-AM Sp. z o.o. outside the submitted work. No other disclosures were reported.

References

    1. Donnelly K, Bracchi R, Hewitt J, Routledge PA, Carter B. Benzodiazepines, Z-drugs and the risk of hip fracture: a systematic review and meta-analysis. PLoS ONE. 2017;12(4):e0174730. doi:10.1371/journal.pone.0174730 - DOI - PMC - PubMed
    1. Amari DT, Juday T, Frech FH, et al. . Falls, healthcare resources and costs in older adults with insomnia treated with zolpidem, trazodone, or benzodiazepines. BMC Geriatr. 2022;22(1):484. doi:10.1186/s12877-022-03165-6 - DOI - PMC - PubMed
    1. Vozoris NT, Fischer HD, Wang X, et al. . Benzodiazepine drug use and adverse respiratory outcomes among older adults with COPD. Eur Respir J. 2014;44(2):332-340. doi:10.1183/09031936.00008014 - DOI - PubMed
    1. Lucchetta RC, da Mata BPM, Mastroianni PC. Association between development of dementia and use of benzodiazepines: a systematic review and meta-analysis. Pharmacotherapy. 2018;38(10):1010-1020. doi:10.1002/phar.2170 - DOI - PubMed
    1. By the 2023 American Geriatrics Society Beers Criteria Update Expert Panel . American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081. doi:10.1111/jgs.18372 - DOI - PubMed

Publication types

Substances