The US Patient Protection and Affordable 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 interprets this in part by asking older adults to refrain from using sleeping pills. Dr Cara Tannenbaum, pharmacy research chair and geriatrician at the Institut universitaire de gériatrie de Montréal and professor at the University of Montreal, decided to see if a “patient empowerment intervention” would decrease sleeping pill usage among this age cohort.
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 intervention was a seven-page handout that described sleeping pill risks and encouraged patients to discuss a tapering protocol with their physician or pharmacist; 62% of seniors who received the intervention spoke to their health provider about reducing sleeping pill consumption. Six months later, 27% no longer took sleeping pills, and another 11% were in the process of tapering. The study concludes that seniors are not given enough credit for being active and able participants in decisions about their healthcare and medication use.
Tannenbaum says her 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,” says Tannenbaum. “The empowerment intervention was equally effective in both sexes.”