15 Apr Sleeping Pills: Education Leads to Dose Reduction By Older Adults
MedicalResearch.com Interview with:
Cara Tannenbaum, MD, MSc
The Michel Saucier Endowed Chair in Geriatric Pharmacology, Health and Aging,Professor of Medicine and Pharmacy
University of Montreal Centre de Recherche
Institut Universitaire de Gériatrie de Montréal
MedicalResearch.com: What are the main findings of the study?
Dr. Tannenbaum: The EMPOWER study showed that providing older patients with information about the harms of sleeping pill use led to discontinuation or dose reduction in 1-in-every 4 patients with longstanding use of benzodiazepines. Receipt of evidence-based information about drug harms resulted in a 8-fold higher likelihood of benzodiazepine cessation. Many physicians think that patients become too dependent on sedative-hypnotics to successfully discontinue. Regardless of age, sex, and duration of use, 27% of patients aged 65-95 in this study successfully completed the recommended 20-week tapering protocol during a 6-month time period and another 11% were in the process of tapering. EMPOWERing patients with evidence-based information therefore results in appropriate risk reduction.
MedicalResearch.com: Were any of the findings unexpected?
Dr. Tannenbaum: What was surprising was the number of physicians and pharmacists who counseled patients NOT to discontinue benzodiazepine therapy. There is growing evidence that even p.r.n use of sedative hypnotics – including classic benzodiazepines and the newer Z-drugs – increases the risk of falls by 57%, with a two-fold greater risk of fractures. Use of sleeping pills has also been conclusively associated with cognitive impairment and motor vehicle accidents in older adults. De-prescribing at any age should be attempted, with substitution of non-pharmacologic strategies for the treatment of insomnia or anxiety.
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr. Tannenbaum: The main message is that older adults can actively participate in safer medication management and should be included in decisions around continued use of medications that increase the risk of harm.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Tannenbaum: It would be interesting to better understand the deterrents physicians face in de-prescribing inappropriate prescriptions. Judicious prescribing for older adults involves elimination of medications such as sedative hypnotics that increase the risk of harm. Why then, do so many physicians and pharmacists continue to renew prescriptions for these offending medications? Especially when both the American Board of Internal Medicine and the American Geriatrics Society asks then to “Choose Wisely”.
Tannenbaum C, Martin P, Tamblyn R, Benedetti A, Ahmed S. Reduction of Inappropriate Benzodiazepine Prescriptions Among Older Adults Through Direct Patient Education: The EMPOWER Cluster Randomized Trial. JAMA Intern Med. 2014;():. doi:10.1001/jamainternmed.2014.949.