Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
Drugs Aging. 2010 Nov 1;27(11):915-24. doi: 10.2165/11584480-000000000-00000.
Many older individuals suffer from difficulty initiating and maintaining sleep, and consequently use hypnosedative medication. The use of sleeping tablets, usually benzodiazepines (BZs) and the newer Z drugs such as zolpidem, is largely unnecessary and problematic since their efficacy is not maintained over an extended period of time and they increase the risk of falls. Withdrawing these medications is challenging because of their propensity for causing dependence and rebound insomnia.
To describe the use of anxiolytic and hypnosedative medications by patients attending a falls clinic, determine the success of recommendations to cease or reduce use of these medications, and evaluate patient characteristics influencing the success of these recommendations.
Patients with a first appointment at an Australian falls clinic between January 2006 and December 2008 were identified from letters written by the geriatrician or rehabilitation physician who ran the clinic. Patients who were taking a BZ/Z drug, had attended a follow-up appointment at least 2 months after their index appointment and had received a documented recommendation to alter their BZ/Z drug use at the index appointment were included in this study. The associations between compliance with the specialist physician's recommendation to alter the BZ/Z drug and BZ/Z drug dose, frequency and duration, patient's age, sex, residence, co-morbidities and number of regular medications were assessed. Inter-clinician variation in the proportion of patients receiving a follow-up appointment, recording of BZ/Z drug use and the proportion of patients given a recommendation to alter BZ/Z drug use were also analysed in the broader population of all patients receiving a first appointment at the falls clinic in the study period.
Data from 302 patient records revealed that 21.5% of patients were using a BZ/Z drug and 27.8% were using any drug for its hypnosedative properties. Over the 3-year study period there was a reduction in BZ use, which was countered by an increase in the use of zolpidem, so that the overall use of BZ/Z drugs did not change. Of those patients taking a BZ/Z drug, 48% (31/65) were followed up and had a documented recommendation to alter their BZ/Z drug use. At least 68% (21/31) of these patients were compliant at follow-up. Patients who were assessed by a geriatrician were more likely to be advised to alter their BZ use than those assessed by a rehabilitation specialist (p = 0.002). Patients were more likely to be compliant if they were given a recommendation to cease their BZ/Z drug compared with advice to reduce the dose or to gradually reduce the dose with the aim of cessation (p = 0.019). There were no sex- or age-specific differences in compliance. Patients who were successful in ceasing or reducing BZ/Z drug use showed nonsignificant trends toward having a reduced number of co-morbidities and regular medications, and lower frequency of use of BZ/Z drugs.
We observed a constant proportion of falls clinic patients taking BZs or Z drugs between 2006 and 2008. Specialist recommendation to cease or reduce dosage of these medications was associated with a high success rate.
许多老年人存在入睡困难和睡眠维持困难的问题，因此会使用催眠镇静药物。这些药物通常是苯二氮䓬类药物（BZs）和新型 Z 类药物，如唑吡坦，使用这些药物在很大程度上是不必要的，而且存在问题，因为它们的疗效无法长期维持，并且会增加跌倒的风险。由于这些药物容易引起依赖和反弹性失眠，因此停药具有挑战性。
描述在跌倒诊所就诊的患者使用抗焦虑和催眠镇静药物的情况，确定停止或减少使用这些药物的建议的成功率，并评估影响这些建议成功率的患者特征。
从 2006 年 1 月至 2008 年 12 月在澳大利亚跌倒诊所首次就诊的患者的信件中确定了患者。包括正在服用 BZ/Z 药物、在索引就诊后至少 2 个月就诊过且在索引就诊时接受过改变 BZ/Z 药物使用的书面建议的患者。评估了遵守专家医生改变 BZ/Z 药物使用的建议与 BZ/Z 药物剂量、频率和持续时间、患者年龄、性别、居住地、合并症和常规药物数量之间的关系。还分析了在研究期间所有在跌倒诊所首次就诊的患者中，医生之间在随访预约、记录 BZ/Z 药物使用和给予改变 BZ/Z 药物使用建议的比例方面的差异。
来自 302 份患者记录的数据显示，21.5%的患者正在使用 BZ/Z 药物，27.8%的患者正在使用任何具有催眠镇静作用的药物。在 3 年的研究期间，BZ 的使用有所减少，而唑吡坦的使用有所增加，因此 BZ/Z 药物的总体使用量并未改变。在服用 BZ/Z 药物的患者中，有 48%（31/65）接受了随访，并记录了改变 BZ/Z 药物使用的建议。至少有 68%（21/31）的患者在随访时遵守了建议。与接受康复专家评估的患者相比，接受老年病学家评估的患者更有可能被建议改变其 BZ 使用（p=0.002）。与减少剂量或逐渐减少剂量以达到停药目的的建议相比，给予停止 BZ/Z 药物的建议时患者更有可能遵守（p=0.019）。在遵守方面没有性别或年龄特异性差异。成功停止或减少 BZ/Z 药物使用的患者在合并症和常规药物数量减少、BZ/Z 药物使用频率降低方面表现出无显著意义的趋势。
我们观察到 2006 年至 2008 年间，跌倒诊所患者使用 BZs 或 Z 药物的比例保持不变。专家建议停止或减少这些药物的剂量与高成功率相关。
