A recent article published in the Journal of the American Geriatrics Society examines the effectiveness of interventions aimed at reducing the use of benzodiazepine receptor agonists (BZRA), commonly known as benzos, among older adults and individuals with cognitive impairment. The findings indicated that while some interventions were successful in helping patients discontinue these medications, the success rates varied significantly, ranging from as low as 9% to as high as 100%.
The systematic review, led by Aisling M. McEvoy of Monash University, aimed to assess which non-pharmacological, patient-directed strategies were most effective in deprescribing BZRAs, a drug category that includes both benzodiazepines and “z-drugs” like zolpidem. Notably, the researchers found no apparent difference in effectiveness between patients with and without cognitive impairments. They write:
“A range of patient-directed interventions were tested, primarily written and verbal education. All studies reported BZRA cessation following the intervention; however, the proportion of participants who stopped their BZRA varied widely. Some studies reported a significant difference between the intervention and control groups, and others did not. This may be due to the high levels of heterogeneity in study designs, interventions, settings, sample sizes, and participant demographics.”
This study underscores the persistent gap between clinical prescribing practices and evidence-based safety for aging populations, highlighting how deeply entrenched assumptions about pharmaceutical solutions continue to shape care, even in the face of well-documented harms. By revealing the wide variation in outcomes despite educational and behavioral interventions, the research points to the structural barriers that complicate efforts to reduce dependence on medications like benzodiazepines and z-drugs. The findings suggest that meaningful change requires a reevaluation of the institutional logics that normalize long-term sedative use among older adults, often at the cost of their well-being and autonomy.
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