Feasibility of discontinuing chronic benzodiazepine use in nursing home residents: a pilot study
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Guidelines discourage chronic benzodiazepines and related Z drugs (BZD/Zs) for sleep problems. However, prevalence among nursing home residents remains high. Discontinuing these drugs is widely recommended but seems difficult to implement. The aim of our study was to evaluate the overall feasibility in the nursing home, in terms of willingness towards discontinuation and success rate at 8 months, together with the impact on withdrawal symptoms, change in sleep quality, quality of life and medication use.
In a convenience sample of five nursing homes (823 residents), we included cognitively competent residents with chronic BZD/Z use for insomnia. We investigated sleep quality [with Pittsburgh Sleep Quality Index (PSQI)], quality of life (EQ-5D) and withdrawal symptoms [Benzodiazepine Withdrawal Symptom Questionnaire (BWSQ)]. Success rate was analysed with survival analysis.
Of the 135 eligible residents, both general physician (GP) and resident were willing to initiate discontinuation in 38 residents. Reasons for refusing to initiate discontinuation among GPs was the unmotivated patient and among residents the reluctance towards change. At 8 months, 66.0 % were successful discontinuers, with the subjective PSQI component evolving favourably (p = 0.013) and a decreasing number of midnight awakenings (p = 0.041). In the relapse group (n = 13), the quality of life decreased (p = 0.012), with mainly an increase of problems with activities and pain/discomfort. In both groups, the withdrawal symptoms, functionality and medication use did not change.
Discontinuation of chronic BZD/Z use is feasible in the nursing home setting without noticeable withdrawal symptoms, without a switch in medication use, without detrimental effect on quality of life and with a positive effect on the self-perceived sleep quality.
KeywordsBenzodiazepine Nursing homes Sleep problems Discontinuation
We thank all participating nursing homes, the general physicians and, especially, the head nurses for their collaboration.
Contribution of authors
J. Bourgeois formulated the research question, did the date collection, performed analyses and wrote the paper.
M. Elseviers formulated the research question, did the supervision of the statistical analyses and assisted with writing the paper.
M. Petrovic assisted with writing the paper and gave input from a clinical geriatric point of view.
L. Van Bortel assisted with writing the paper.
R. Vander Stichele formulated the research question, assisted with writing the paper and helped interpret the results.
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