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 "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: http://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.
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"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.
 ___
Source: http://bit.ly/1kEuu5o
JAMA Internal Medicine, online April 14, 2014.
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