Barriers to discontinuation of chronic benzodiazepine use in nursing home residents: Perceptions of general practitioners and nurses

Background/AimPrescription guidelines caution against chronic benzodiazepine (BZD) use. Nevertheless, chronic use among older adults, especially in nursing homes is widespread. We wanted to explore why it is difficult to implement discontinuation. We focused on individual residents that used BZDs and explored benefit and harm of chronic BZD use, willingness to try and barriers against the discontinuation of chronic BZD use.MethodsIn this cross-sectional study, we selected nursing home residents with at least 3 months of BZD use. A resident-specific questionnaire was addressed to the GP and to the responsible nurse and questioned effectiveness, side effects, initiation and willingness to stop. For every resident, the GP and nurse had to score 8 barrier statements on a 10-point Likert scale. Additionally, we collected 10 general attitudes scored by GPs and nurses.ResultsWe received data for 109 chronic BZD users. GPs and nurses indicated that the BZD still had the desired effect in respectively 87% and 83% of the 109 residents and in 75% and 70% they observed no side-effect. Dependence was seen in respectively 41% and 28%. Overall, the GPs had higher barriers than the nurses but indicated a higher willingness to stop (33% vs. 21%). Both caregivers were willing to stop in 13% of the residents.ConclusionThe perceived effectiveness, the absence of side-effects and the presence of dependence in most residents on chronic BZD use resulted in a low willingness to stop. Future discontinuation guidelines should consider all caregivers’ perceptions and promote a multidisciplinary approach.