What are the barriers to deprescribing benzodiazepines in older adults in a survey of European physicians?

According to a 2025 survey involving physicians from six European countries, major barriers to deprescribing benzodiazepines (BZRA) include insufficient staff and time, coupled with patient reluctance. The survey was designed to answer the question, "What are the barriers to deprescribing benzodiazepines in older adults in a survey of European physicians?", revealing complex challenges within the healthcare system that hinder effective geriatric care.

Quick Summary

A 2025 survey of European physicians revealed significant barriers to deprescribing benzodiazepines in older adults, such as patient and physician reluctance, resource constraints, and insufficient training. The findings highlight the need for tailored interventions to address health-system and patient-related factors affecting deprescribing practices.

Key Points

• Patient Reluctance is a Major Barrier: A significant obstacle is the patient's strong reluctance to stop benzodiazepines, often fueled by fears of withdrawal symptoms or returning sleep issues, which physicians cite as a source of patient pressure.

• Systemic Resource and Time Constraints: Insufficient time for consultations and lack of adequate staffing are major health-system barriers, making the complex and time-consuming process of deprescribing difficult to implement effectively.

• Inadequate Physician Training: Many physicians, particularly those in general practice and hospitals, report a lack of formal training in specific deprescribing techniques, patient communication strategies, and alternative non-pharmacological treatments.

• Health System De-Prioritization: Deprescribing BZRAs is often given low priority by the healthcare system and individual physicians, who prioritize other, seemingly more urgent, patient health issues.

• Communication and Coordination Gaps: Poor communication between different care settings, like hospitals and primary care, can disrupt deprescribing efforts, as one physician's actions may be reversed by another who is unaware of the plan.

• Psychological and Emotional Factors: Physicians often experience frustration and low self-efficacy related to the challenges of managing withdrawal and patient resistance, adding to the emotional burden of the deprescribing process.

Survey Reveals Primary Obstacles to Deprescribing

A multi-country survey of European healthcare providers, published in 2025, highlighted several critical barriers to deprescribing benzodiazepine receptor agonists (BZRAs) in older adults. This study included responses from 240 hospital physicians and 96 general practitioners (GPs) across six countries: Belgium, Greece, Norway, Poland, Spain, and Switzerland. The results, based on the Theoretical Domains Framework (TDF), showed major barriers are consistent across countries and physician types, with differences mainly in moderate barriers and enablers.

Key Physician-Reported Barriers

Major barriers were identified across several domains, indicating systemic issues and individual challenges. Physicians reported feeling frustrated with the complexities of deprescribing and prioritized other pressing health issues over BZRA discontinuation. The perceived lack of self-efficacy—or confidence in their ability to manage the process—was also a major barrier. Moreover, training was a significant point of concern; many participants reported a lack of formal education on how to engage patients effectively about deprescribing or implement alternative therapies.

Health-System Limitations and Patient Reluctance

Environmental and resource-related factors were also consistently identified as major hurdles. A lack of time and insufficient staffing were frequently cited, preventing the necessary follow-up for successful deprescribing. The survey also revealed that many physicians felt the healthcare system did not prioritize BZRA deprescribing, and a lack of local hospital policies further contributed to inaction. Compounding these systemic issues is strong patient reluctance, driven by a fear of withdrawal symptoms or a return of the original sleep problems. Many physicians also felt pressure from patients or their relatives to renew prescriptions, highlighting the influence of patient-driven requests on clinical practice.

Comparison of Deprescribing Barriers: System vs. Patient

To better understand the multifaceted nature of this challenge, it's helpful to categorize the identified barriers into systemic/health-system factors versus patient-related and individual physician factors.

Barrier Category	Systemic / Health-System Factors	Patient & Physician-Related Factors
Resource Constraints	Insufficient staff and a lack of time for comprehensive deprescribing processes.	Physician time constraints during regular appointments, which can make initiating complex deprescribing conversations difficult.
Knowledge & Training	Absence of formal training programs for deprescribing, engaging patients, and using non-pharmacological alternatives.	Low self-efficacy and a belief that they lack the skills needed to successfully manage the deprescribing process.
Policy & Guidelines	Lack of local or institutional policies prioritizing BZRA deprescribing.	Physician uncertainty regarding how to taper BZRA in older adults, compounded by limited evidence and decision support tools.
Perceived Priority	Hospital administration or health system's low prioritization of BZRA deprescribing relative to other health issues.	Physician prioritization of other health issues perceived as more urgent or important by the patient.
Patient Influence	Poor communication and fragmented care between hospital and primary care settings, potentially undoing deprescribing efforts.	Strong patient reluctance to discontinue BZRA due to fear of withdrawal or symptom recurrence.

Overcoming Hurdles in Practice

Physicians cited frustration with the long, drawn-out process of tapering, which can last weeks or months. Additionally, some were hesitant to stop medications initiated by another provider, especially if the original indication was unclear. Communication breakdowns between different healthcare settings and poor coordination of care were also cited as significant issues, with general practitioners expressing concern that hospital physicians might re-prescribe discontinued BZRAs.

Strategies for Enhanced Deprescribing

To address these barriers, several strategies are needed, according to the survey findings. Enhanced training and education for physicians on deprescribing protocols, patient communication, and non-pharmacological alternatives are essential. Involving multidisciplinary teams, including pharmacists, has been shown to improve success rates. Providing patients with clear information and involving them in shared decision-making can also increase buy-in and motivation. Furthermore, system-level changes, such as allocating more time for appointments and implementing clear institutional policies that support deprescribing, are crucial.

Conclusion

In conclusion, a recent survey of European physicians provides clear insight into the significant barriers hindering the deprescribing of benzodiazepines in older adults. The primary challenges identified include insufficient resources and time within the healthcare system, a lack of specific deprescribing training for physicians, and strong patient reluctance often driven by fears of withdrawal or symptom rebound. Addressing these barriers requires a multi-pronged approach, encompassing better healthcare system support, improved physician training, and more effective patient-centered communication strategies. By tackling these issues, healthcare providers can improve patient safety and outcomes, reducing the risk associated with prolonged benzodiazepine use in the geriatric population.

Frequently Asked Questions

What is benzodiazepine deprescribing?

Benzodiazepine deprescribing is the supervised process of reducing the dosage of, tapering, and ultimately discontinuing benzodiazepine medications in patients, particularly older adults, to mitigate risks such as cognitive impairment, falls, and dependence.

Why is deprescribing benzodiazepines especially important for older adults?

Older adults have increased sensitivity to benzodiazepines and slower metabolism, which raises their risk of serious adverse effects like cognitive impairment, delirium, fractures from falls, and motor vehicle crashes. The benefits often no longer outweigh these risks.

What role does a lack of time play in deprescribing?

A lack of time is a major barrier reported by physicians, who find it difficult to allocate the significant time and follow-up needed for successful deprescribing conversations and monitoring during a standard consultation.

How does patient reluctance affect deprescribing?

Patient reluctance, often driven by fear of withdrawal symptoms or insomnia returning, is a significant barrier. Physicians report feeling pressure from patients to continue prescriptions, making it harder to initiate the deprescribing conversation.

What role does physician training have in deprescribing success?

Formal training in deprescribing, patient communication, and non-drug alternatives is crucial. The survey indicated a widespread lack of this specific training among European physicians, contributing to low self-efficacy and reluctance to start the process.

What are some systemic or policy-level barriers?

Systemic barriers include insufficient staff, low prioritization of deprescribing at the institutional level, and poor coordination of care between different health settings. The lack of institutional policies to support deprescribing also creates a hurdle.

How can the patient-physician relationship impact deprescribing?

Building a strong, trusting patient-provider relationship is cited as a key facilitator. Conversely, if trust is low, patients may view deprescribing as an "abandonment of care," and physicians may be hesitant to be too aggressive in their approach for fear of losing the patient.