Safety and effectiveness of strategies to deprescribe chronic benzodiazepine receptor agonist use in older adults: a systematic review

BACKGROUND: Chronic use of benzodiazepine receptor agonists (BZRAs) remains common among adults aged 65 years and older, despite long-standing concerns regarding falls, cognitive impairment, functional decline and other adverse outcomes. Multiple strategies to support the deprescribing of BZRAs have been proposed; however, the safety and effectiveness of these deprescribing interventions in older adults have not been comprehensively synthesized across different intervention types. OBJECTIVE: To synthesize the available evidence on the safety and effectiveness of structured strategies to deprescribe chronic BZRA use in adults aged ≥65 years. METHODS: This systematic review was conducted in accordance with PRISMA 2020 guidelines. Ovid MEDLINE, PubMed, Embase and PsycINFO were searched from database inception to September 2025. Randomized and nonrandomized studies evaluating structured BZRA-deprescribing interventions in older adults were included. Risk of bias was assessed using design-appropriate tools, and findings were synthesized narratively due to substantial heterogeneity. RESULTS: Thirty studies involving ~11 000 older adults were included. Interventions encompassed structured pharmacologic tapering, patient-directed educational strategies, clinician-led approaches and system-level interventions. Across strategies, deprescribing was generally safe, with withdrawal symptoms typically mild and transient and serious adverse events rare. Structured gradual tapering achieved the highest rates of discontinuation or dose reduction, while other approaches demonstrated more variable effectiveness. CONCLUSION: Deprescribing chronic BZRA use in older adults is feasible and generally safe when implemented using structured, gradual and patient-centred approaches. Effectiveness varies by intervention type and context, supporting an individualized, evidence-informed approach to deprescribing in geriatric practice. PROTOCOL REGISTRATION: International Prospective Register of Systematic Reviews (PROSPERO): CRD420251186411.