Educating older patients helps taper off sleeping pill use

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Older people are willing and able to get themselves off medications like sleeping pills once they're informed of the potential harms, according to a new Canadian study.

"Even among patients who have been taking sleeping pills for 30 years, many of them in their 80s and 90s were able to get off the sleeping pills once they realized that these pills could cause falls, memory problems and car accidents," lead author Dr. Cara Tannenbaum of the University of Montreal told Reuters Health.

While Valium, Xanax and similar medications, known as benzodiazepines, are not recommended for older adults given such risks, up to one-third of older adults still take them, usually to treat insomnia or anxiety, according to Tannenbaum and her colleagues.

Doctors know about the dangers these drugs pose to their patients, the investigators write in JAMA Internal Medicine, but nearly half say they renew benzodiazepine prescriptions for their older patients anyhow, "citing patient dependence and benefit as justifications."

Tannenbaum's team wanted to see whether educating older patients taking benzodiazepines about the risks would be an effective way to encourage some to stop using the drugs.

They recruited 303 patients from 30 different pharmacies, then randomly assigned the clients of half the pharmacies to receive a booklet describing the risks of benzodiazepine use, along with instructions on how to taper off the medications safely as well as information on alternative strategies for treating insomnia and anxiety.

A copy of the booklet given to patients taking the drug lorazepam (Ativan) is available as a PDF file on the journal's website (here: bit.ly/1r2Z4p7) for the next 30 days.

Patients who used the other 15 pharmacies served as a comparison group that continued receiving their usual care.

Overall, the researchers found, 62 percent of the patients who received the booklets initiated a conversation with their doctor or pharmacist about getting off benzodiazepines.

Six months into the study, 27 percent of the patients who received the booklets had stopped taking benzodiazepines, versus 5 percent of the comparison group.

Patients in the study ranged from 65 to 95 years old, and even the oldest patients were able to succeed in discontinuing the medication, Tannenbaum and her team point out in their report.

Many types of drugs, including benzodiazepines, can be harmful to older people even if they are relatively safe in younger adults, Tannenbaum said.

As we age, she explained, our kidneys have to work harder to clear medication from our bodies, meaning drugs can build up to higher levels in the blood. Compounding the problem is the fact that many older adults are on a host of medications, which can interact with one another to cause dangerous side effects.

"I think medicine these days is more about choices, and I think that patients have to be informed about the different choices," Tannenbaum added. "A lot of people believe that when you start a medication then you can never stop it . . . there's always room to question these decisions depending on what's important to the patient at that time."

For example, she said, a younger person may want to take a benzodiazepine so she can be sure to get enough sleep before a big presentation. But when she gets older, she may decide that the side effects - like morning drowsiness and fuzzy memory - aren't worth the risk, and opt for non-drug strategies for sleeping better.

"It's this dynamic nature of medicine that's really changing, because people are living longer and their priorities change," Tannenbaum said.

Older patients who take benzodiazepines are twice as likely to have unwanted side effects as they are to have improved sleep, according to Dr. Ariel Green, a geriatrics specialist at Johns Hopkins Medicine in Baltimore.

"They really have meager benefit and it's far outweighed by substantial risks," said Green, who was not involved in the new study but took part in the American Geriatrics Society's Choosing Wisely Workgroup, which developed the recommendation against using benzodiazepines as first-line treatment for insomnia in older adults.

"This study is good evidence that people, when presented with these risks, are really eager and able to change these habits," Green told Reuters Health.

She said that older patients on benzodiazepines for insomnia may want to talk with their doctor about stopping them.

"They can safely stop these medications with their doctor's help, and there are nonpharmacological approaches for improved sleep that are safer and have actually been shown to be more effective," Green said.