New modeling from the University of Southern California suggests avoiding prescription sleep drugs could lower fall risk and cognitive impairment while increasing life expectancy.
Key takeaways:
- Avoiding sleep medications could reduce the lifetime incidence of falls by 8.5% and cognitive impairment by 2.1% in older adults.
- The modeling projects an increase in life expectancy of 1.3 months, translating to 1.7 million life-years gained across the US population.
- Adults aged 65 to 74 saw the largest potential benefit in cognitive and physical health, suggesting a target group for prescribing interventions.
- Researchers recommend cognitive behavioral therapy for insomnia (CBT-I) as a first-line alternative to pharmacotherapy.
- Reducing prescriptions could yield lifetime savings of $6,600 per person, totaling about $101 billion nationwide.
A new study from the USC Schaeffer Center for Health Policy & Economics finds that reducing prescriptions of sleep medication in older adults could provide substantial health and economic benefits. The research was published in The Lancet Regional Health – Americas.
According to the study’s modeling, avoiding these medications would reduce the lifetime incidence of falls by 8.5% and cognitive impairment by 2.1%. Researchers also found it would increase life expectancy by 1.3 months, which translates to 1.7 million life-years gained across the population.
“Our results show reducing use of sleep medications could help older adults live healthier lives with fewer limitations,” says lead author Hanke Heun-Johnson, a research scientist at the Schaeffer Center, in a release.
An estimated 15.3 million US adults ages 50 and older take prescribed sleep medications, such as benzodiazepines and “Z-drugs,” despite warnings from medical societies about risks including dependence and cognitive impairment.
For the study, researchers used a dynamic microsimulation model, the Future Elderly Model, to project the impacts of sleep medication use. They compared current use with a scenario in which no older adults use the drugs, examining outcomes like fall risk, cognitive decline, and medical costs.
The analysis identified people ages 65 to 74 as seeing the largest potential benefit in cognitive function and physical health from avoiding these drugs, suggesting that efforts to reduce prescribing should focus on this age group.
In addition to health benefits, researchers calculated lifetime savings of $6,600 per person, or about $101 billion across the US, with most savings derived from improvements in quality of life.
The study highlights recommendations from organizations like the American Academy of Sleep Medicine, which advocate for cognitive behavioral therapy for insomnia (CBT-I) as a first-line treatment. CBT-I is noted to be as effective as medication in the short term and more effective long-term, without the side effects.
The authors suggest that interventions used to reduce inappropriate prescribing of other medications could be adapted for sleep drugs. These include using electronic health record systems to prompt physicians to justify prescriptions for older patients or providing periodic reports that compare a physician’s prescribing patterns with those of their peers.
“Insomnia is a serious issue for many older adults, but regular use of sleep medication can pose real risks. Supporting physicians in reducing prescriptions and promoting safer, proven alternatives will ultimately benefit patients and society,” says co-author Jason Doctor, a senior scholar at the Schaeffer Center and the Norman Topping Medical Enterprise Chair in Medicine at the USC Price School of Public Policy, in a release.
