Discontinuing Benzodiazepine Therapy: An Interdisciplinary Approach at a Geriatric Day Hospital

Abstract

Background: Despite the known adverse effects of benzodiazepines, elderly people commonly use these drugs over long periods to treat insomnia and anxiety. This qualitative study was conducted to examine the experiences of patients and care providers in a geriatric day hospital (GDH) as patients participated in a benzodiazepine tapering process, to identify the components and processes of the benzodiazepine tapering intervention, and to begin exploring how they influence patient outcomes. Methods: The study was conducted in a GDH in a Canadian city. Data were gathered from a discussion group and from individual semistructured interviews with 13 health care providers and 5 patients. Charts were reviewed to gather demographic data and confirm provider activities. A reflexive approach was conducted whereby each care provider reviewed and modified the role description created from information provided during his or her interview. Themes were determined through constant comparative analysis of transcripts, which included 5 meetings of the research team. Results: The tapering of benzodiazepines at the GDH was effected primarily by 3 people: the physician, the pharmacist and the nurse. Other members of the interdisciplinary team were not always aware of which patients were tapering their benzodiazepine therapy, but they supported patients in a variety of ways. The patients included in this analysis were willing to taper their benzodiazepines and did not consider the experience significant in any way. Conclusion: The health care provider roles, processes and tools described here could be replicated in other environments to assist patients who are tapering benzodiazepine therapy. Further research is needed to understand the interrelationships of all components of GDH care to determine their relative importance in facilitating behaviour change related to benzodiazepine tapering.