Abstract
BackgroundThe aim of this study was to determine and compare patients' and physicians' perceptions of benefits and risks of long term benzodiazepine use for insomnia in the elderly.MethodsA cross-sectional study (written survey) was conducted in an academic primary care group practice in Toronto, Canada. The participants were 93 patients over 60 years of age using a benzodiazepine for insomnia and 25 physicians comprising sleep specialists, family physicians, and family medicine residents. The main outcome measure was perception of benefit and risk scores calculated from the mean of responses (on a Likert scale of 1 to 5) to various items on the survey.ResultsThe mean perception of benefit score was significantly higher in patients than physicians (3.85 vs. 2.84, p < 0.001, 95% CI 0.69, 1.32). The mean perception of risk score was significantly lower in patients than physicians (2.21 vs. 3.63, p < 0.001, 95% CI 1.07, 1.77).ConclusionsThere is a significant discordance between older patients and their physicians regarding the perceptions of benefits and risks of using benzodiazepines for insomnia on a long term basis. The challenge is to openly discuss these perceptions in the context of the available evidence to make collaborative and informed decisions.
Highlights
The aim of this study was to determine and compare patients' and physicians' perceptions of benefits and risks of long term benzodiazepine use for insomnia in the elderly
There is a significant discordance between patients aged sixty and over and their physicians regarding the perceptions of risks and benefits of using short acting benzodiazepines for insomnia on a long term basis
When approaching insomnia in patients aged sixty and over, ruling out underlying medical and psychological disorders, medication causes, and environmental factors contributing to insomnia continues to be essential
Summary
The aim of this study was to determine and compare patients' and physicians' perceptions of benefits and risks of long term benzodiazepine use for insomnia in the elderly. Many older people suffer from insomnia and are commonly prescribed benzodiazepines for symptomatic management. Among adults aged 65 and older who live in the community, up to 42% reported difficulty falling asleep or staying asleep [1]. The prevalence of benzodiazepine prescriptions in older people is high: 22.5% of people aged 65 and older in Ontario, Canada reported use of benzodiazepines [2]. Older people are more likely to continue using these medications for extended periods once they are prescribed them [3]. The research available on the benefits and risks of benzodiazepine use for insomnia in older people is surprisingly deficient for the magnitude of this issue. Metaanalyses show a mild to moderate treatment effect in (page number not for citation purposes)
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