The US Patient Protection and Affordable Health Care Act encourages patients to act as their own advocates for reducing unnecessary prescriptions that increase the risk of harm. The American Board of Internal Medicine Choosing Wisely® campaign echoes this message by asking older adults to refrain from using sleeping pills. According to the American Geriatrics Society, these medicines have been linked to memory problems, falls, fractures and motor vehicle accidents. “Many people believe that involving patients in the decision to curtail medical treatments is expecting too much,” says Dr. Cara Tannenbaum, Pharmacy Research Chair and geriatrician at the Institut universitaire de gériatrie de Montréal at the University of Montreal. “On the contrary: we now have evidence that patients who are better informed make smarter choices.”
Dr. Tannenbaum's study, released today by JAMA Internal Medicine, randomized 303 chronic sleeping pill users aged 65 to 95 to receive a patient empowerment de-prescribing intervention in a wait-listed fashion. Participants were recruited from community pharmacies in the region of Quebec, Canada. On average, participants used sleeping pills for 10 years and took approximately 10 different medications per day. The empowerment interventon was a 7-page handout which described the risks of sleeping pill use and encouraged patients to discuss a tapering protocol with their physician or pharmacist. Sixty-two percent of seniors who received the empowerment intervention spoke to their health provider about reducing sleeping pill consumption. Six months later, 27% succeeded in breaking free of the habit, while another 11% were in the process of tapering. “These results are incredible,” affirms Dr. Tannenbaum. “Many older adults are addicted to sleeping pills for years. Provision of the latest scientific knowledge empowered them to take their medication safety into their own hands. They raised the issue with their health care provider and started the cycle rolling for de-prescribing. Just because you take a medication for a long time does not mean you can never get off it.” The study concludes that seniors are not given enough credit for being active and able participants in decisions about their health care and medication use.
Dr. Tannenbaum's findings provide a concrete action plan for implementing the recommendation issued in the Revised Beers Criteria published in the spring of 2012 by the American Geriatrics Society that sleeping pills – and 53 other medications - should be avoided in seniors. “Interestingly, women are more likely to consume sleeping pills than men” explains Dr. Tannenbaum. “The empowerment intervention was equally effective in both sexes. Last year the FDA cut the recommended dose of the sleeping pill zolpidem in half for women. There is growing recognition that certain drugs act more powerfully in females because of women's small size and body composition. There is a need for research to ensure that women are informed of these risks in an effective, timely and scientifically correct fashion.” The empowerment intervention can be found online on the JAMA Internal Medicine website.
About the author
Cara Tannenbaum, MD, MSc, is a geriatrician and researcher in health promotion at the Institut universitaire de gériatrie de Montréal (IUGM). She is also the inaugural Michel-Saucier Endowed Chair in Geriatric Pharmacology, Health and Aging from the Faculty of Pharmacy at the Université de Montréal and a Professor of Medicine at the Université de Montréal. She leads a program of research in epidemiologic and clinical geriatric health. Her clinical practice aims to improve medical care for older people. She was the 2013 recipient of the Canadian Institutes of Health Research Betty Haven's Prize in Knowledge Transfer in Aging.