Barriers to discontinuing benzodiazepine receptor agonists in older adults: a survey of older adults across Europe.

Background
Various factors hinder older adults from discontinuing benzodiazepine receptor agonists (BZRAs). Identifying and prioritising these barriers is essential for designing effective interventions to discontinue BZRAs.Objective
To identify barriers to BZRA discontinuation among older adults and factors associated with their willingness to reduce or stop use.Methods
A cross-sectional survey was conducted among adults 65+ using BZRA for sleep problems, recruited from hospitals across six European countries. Barriers were identified via a 27-item questionnaire grounded in the Theoretical Domains Framework (TDF), which systematically identifies individual and contextual determinants of behaviour. Responses were analysed using descriptive statistics. Multivariable logistic regressions identified factors associated with patients' willingness to reduce or stop BZRA.Results
Among 183 participants, 59.1% were willing to reduce and 42.7% to stop BZRA if recommended by their doctor. Half understood why discontinuation is necessary. Barriers were present for most participants across multiple TDF domains. They included: high satisfaction with BZRA, perceived low risk of side effects, limited coping skills or ability to stop, fear of discontinuation and lack of support from physicians or social networks. Higher scores in the TDF domains of Goals, Emotion and Social Influences were associated with greater willingness to reduce BZRA. These domains and Reinforcement, Environmental context and resources were also linked to a greater willingness to stop.Conclusions
These findings highlight the opportunities and challenges of discontinuing BZRA in older adults. While half know the need to discontinue and are willing to try, future interventions must address pervasive barriers across many behavioural domains.