Abstract
BackgroundEvidence-based mailed educational brochures about the harms of sedative-hypnotic use lead to discontinuation of chronic benzodiazepine use in older adults. It remains unknown whether patients with mild cognitive impairment (MCI) are able to understand the information in the EMPOWER brochures, and whether they achieve similar rates of benzodiazepine discontinuation.MethodsPost-hoc analysis of the EMPOWER randomized, double-blind, wait-list controlled trial that assessed the effect of a direct-to-consumer educational intervention on benzodiazepine discontinuation. 303 community-dwelling chronic users of benzodiazepine medication aged 65–95 years were recruited from general community pharmacies in the original trial, 261 (86%) of which completed the trial extension phase. All participants of the control arm received the EMPOWER brochure during the trial extension. Normal cognition (n = 139) or MCI (n = 122) was determined during baseline cognitive testing using the Montreal Cognitive Assessment questionnaire. Changes in knowledge pre- and post-intervention were assessed with a knowledge questionnaire and changes in beliefs were calculated using the Beliefs about Medicines Questionnaire. Logistic regression was used to compare knowledge gained, change in beliefs and benzodiazepine cessation rates between participants with and without MCI.ResultsComplete discontinuation of benzodiazepines was achieved in 39 (32.0% [24.4,40.7]) participants with MCI and in 53 (38.1% [30.5,46.4]) with normal cognition (adjusted OR 0.79, 95% CI [0.45–1.38]). Compared to individuals with normal cognition, MCI had no effect on the acquisition of new knowledge, change in beliefs about benzodiazepines or elicitation of cognitive dissonance.ConclusionsThe EMPOWER brochure is effective for reducing benzodiazepines in community-dwelling older adults with mild cognitive impairment.Trial registrationOur ClinicalTrials.gov identifier is NCT01148186, June 21st 2010.
Highlights
Evidence-based mailed educational brochures about the harms of sedative-hypnotic use lead to discontinuation of chronic benzodiazepine use in older adults
Participants were taking an average of 10 different medications and reported a mean of 7 comorbidities, with almost one third classifying their health status as unfavorable
One hundred twenty-two (46.7%) participants were classified as having mild cognitive impairment (MCI) at baseline
Summary
Evidence-based mailed educational brochures about the harms of sedative-hypnotic use lead to discontinuation of chronic benzodiazepine use in older adults It remains unknown whether patients with mild cognitive impairment (MCI) are able to understand the information in the EMPOWER brochures, and whether they achieve similar rates of benzodiazepine discontinuation. Sedative-hypnotic use is associated with cognitive impairment, and may contribute to mild neurocognitive disorders in older adults [1,2,3]. For this reason, both long and short-acting benzodiazepines are listed in the 2015 Beers criteria of medications to avoid in older adults [3]. Longitudinal data suggest that medical decision-making capacity in patients with MCI tends to decline over time [8]
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