Benzodiazepine deprescription in at-risk inpatients: an MUHC pilot study

Introduction: Older adults frequently have multiple medical conditions leading to concurrent use of five or more drugs (polypharmacy). Those admitted to hospital are particularly vulnerable to adverse drug events from... [ view full abstract ]

Introduction: Older adults frequently have multiple medical conditions leading to concurrent use of five or more drugs (polypharmacy). Those admitted to hospital are particularly vulnerable to adverse drug events from polypharmacy. Common, potentially harmful medications include benzodiazepines and non-benzodiazepine sedatives, often prescribed for sleep. Choosing Wisely Canada recommends against their use as a first line choice for insomnia, agitation or delirium.

We retrospectively assessed 2179 patients admitted to the medical clinical teaching units from December 2013 to April 2015 and determined that 389 (18%) were receiving a sedative prior to admission. Of these, 57% were 65 or older and 40% were over age 80. In 2014, Tannenbaum et al. demonstrated that EMPOWER, a patient-directed educational pamphlet, led to 27% of community dwelling adults discontinuing benzodiazepines, compared to 5% of those receiving usual care.

Methods: We introduced the EMPOWER pamphlet to patients over age 60 admitted to our CTUs. Our primary outcome was a sustained cessation of pre-hospital use of sedatives at 90 days post discharge. Cessation was evaluated using Dossier Sante du Quebec prescription records, while sleep-related outcomes were evaluated by telephone 30 days post intervention. 

Results: 64% of patients enrolled were maintained off of their sedative at 30-days post discharge.  The intervention resulted in no adverse impact on self-reported quality of sleep at 30-days among patients who were able to successfully discontinue their sedative at discharge. We did not demonstrate any significant impact on number of falls given these are rare events.

Discussion: The preliminary results of this small study suggest that this type of consumer detailing, combined with small educational interventions, can be successfully implemented on the CTU, despite complex patient co-morbidities and acute illness, without significant impact on self-reported sleep quality. Future directions will include following patients for up to six-months for long-term data on intervention sustainability.