How to Stop Benzodiazepines in Older Adults

Practical guidance on a complex problem

STUDY: O’Hara-Veintimilla K et al, Age and Ageing 2026;

STUDY TYPE: Systematic review

FUNDING: Norwegian Health Association; Norwegian government (Helse Vest)

Background

Benzodiazepines and Z-drugs are widely prescribed to older adults despite well-documented risks — falls, fractures, respiratory illness, cognitive impairment, and delirium. This review looks for the most successful deprescribing strategies.

The Study

• Thirty studies involving roughly 11,000 adults aged 65 and older, testing various desprescribing strategies.
• Settings included primary care, nursing homes, and hospitals across North America, Europe, and Oceania.
• Follow-up ranged from weeks to two years.

Structured gradual tapering was the most effective strategy, achieving discontinuation or major dose reduction in 60–82% of participants. Withdrawal symptoms were common but mild and transient. No study reported seizures, delirium, or hallucinations.

Patient-directed education (mailed materials, brief counseling) produced more modest but consistent results, with discontinuation rates of 22–27% at six months.

Clinician-led and system-level approaches improved prescribing quality at the population level but showed variable individual results.

Adjunctive meds for withdrawal added little.

Practice Implications

1. Gradual, individualized dose reduction is what works
2. If your older patient has been on a benzodiazepine for months or years, start the conversation. Send educational materials first if they’re not ready to taper. When they are, reduce the dose by 5–25% every few weeks, monitor for anxiety or insomnia, and don’t rush it.
3. For patients with severe psychiatric comorbidity or palliative care needs, continued use may still be appropriate.