Helping older adults discontinue using sedatives

Older adults, especially those who are admitted to hospitals, are at risk for potentially dangerous side effects if they are taking multiple medicines. Taking several medications at the same time is called polypharmacy. Of special concern are benzodiazepine and non-benzodiazepine sedative hypnotics. These medications, which include lorazepam, clonazepam, zopiclone, and others, are often prescribed for sleep--despite the fact that organizations like the American Geriatrics Society recommend that they not be used as a first choice for sleep problems, agitation, or delirium (the medical term for an abrupt, rapid change in mental function).

As many as one in three older adults receive sedatives while they are hospitalized, and many are given new prescriptions for them when they leave the hospital. This can put older adults at risk for falls, fractures, problems with thinking and making decisions, and even death.

In a new study, published in the Journal of the American Geriatrics Society, researchers looked at a way to help older adults taper off and stop using sedatives. This was based on an earlier study that suggested giving older adults the following:

* an educational brochure outlining the problems that sedatives pose

* instructions for safely taking themselves off the medication.

In the earlier study, having this information helped 27 percent of older adults stop taking the sedatives, compared to 5 percent who didn't receive the information. The researchers then designed their study to test whether a brochure called "EMPOWER," along with support from healthcare personnel at the time of hospitalization, could help older at-risk adults stop taking sedatives.

Sixty-two patients 65-years-old or older who had prescriptions for sedatives agreed to participate in the study. The study took place at the Royal Victoria Hospital in Montreal, Canada. The study participants received EMPOWER brochures and were encouraged to talk with members of the medical team if they wanted to stop taking sedatives. One month after their discharge from the hospital, researchers interviewed the participants about their sedative use and the quality of their sleep.

Participants were around 79-years-old. Nearly 70 percent were moderately to severely frail, and 42 percent said they had a fall within the past month. Frailty, a condition that affects 10 percent of people aged 65 and older, can make older adults more prone to disability, falls, hospitalization, and a shorter lifespan.

Among those who participated in the 30-day follow-up, 64 percent successfully stopped taking sedatives. That's three times the number of people who were able to stop before the EMPOWER program was launched. What's more, 94 percent of the participants who stopped taking sedatives said their sleep problems were about the same as when they were taking medication.

The researchers concluded that the EMPOWER program was safe for hospitalized older adults. They noted that future studies are needed to see whether this kind of program could help reduce adverse drug events (the medical term for serious side effects from medication) for frail older adults who take multiple medications for chronic health conditions.

This summary is from "EMPOWERing hospitalized older adults to deprescribe sedative hypnotics: a pilot study". It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Marnie Goodwin Wilson, MD MSc; Todd C. Lee, MD MPH; Aaron Hass, MSc; and Cara Tannenbaum, MD.

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This research summary was developed as a public education tool by the Health in Aging Foundation. The Foundation is a national non-profit established in 1999 by the American Geriatrics Society to bring the knowledge and expertise of geriatrics healthcare professionals to the public. We are committed to ensuring that people are empowered to advocate for high-quality care by providing them with trustworthy information and reliable resources. Last year, we reached nearly 1 million people with our resources through HealthinAging.org. We also help nurture current and future geriatrics leaders by supporting opportunities to attend educational events and increase exposure to principles of excellence on caring for older adults. For more information or to support the Foundation's work, visit http://www.HealthinAgingFoundation.org.

Included in more than 9,000 library collections around the world, the Journal of the American Geriatrics Society (JAGS) highlights emerging insights on principles of aging, approaches to older patients, geriatric syndromes, geriatric psychiatry, and geriatric diseases and disorders. First published in 1953, JAGS is now one of the oldest and most impactful publications on gerontology and geriatrics, according to ISI Journal Citation Reports®. Visit wileyonlinelibrary.com/journal/JGS for more details.

Founded in 1942, the American Geriatrics Society (AGS) is a nationwide, not-for-profit society of geriatrics healthcare professionals that has--for 75 years--worked to improve the health, independence, and quality of life of older people. Its nearly 6,000 members include geriatricians, geriatric nurses, social workers, family practitioners, physician assistants, pharmacists, and internists. The Society provides leadership to healthcare professionals, policymakers, and the public by implementing and advocating for programs in patient care, research, professional and public education, and public policy. For more information, visit AmericanGeriatrics.org.