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The use of benzodiazepines has been advised against in older people, but
prevalence rates remain high.
To review the evidence for interventions aimed at reducing benzodiazepine
use in older people.
We conducted a systematic review, assessment of risk of bias and
meta-analyses of randomised controlled trials of benzodiazepine
withdrawal and prescribing interventions.
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).
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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