clinical focus
Give sleeping pills a rest
Dr Fiona Williams
Benzodiazepines have only short-term benefits in treating insomnia but some older Australians are using them for years.
Fiona Williams interviewed by Dallas Bastian
Older Australians are using sleeping tablets for longer than what’ s recommended and it may be better if they lay off them altogether, recent research shows.
The study, published in the journal Australian Family Physician, finds that patients are often unaware of the side-effects and addictive traits of benzodiazepines, with some using the drug for more than 20 years, despite studies showing they provide limited benefit when taken for longer than two to four weeks.
Study lead Dr Fiona Williams, from the University of Wollongong School of Medicine, says it’ s estimated that 15 per cent of Australians aged 65 and older use benzodiazepines.
“ Benzodiazepines have a significant negative health impact on the elderly, including an increased risk of falls, fractures, road-traffic accidents and cognitive decline, yet they continue to be used,” Williams says.
Her team surveyed elderly patients in the Illawarra region about their use and knowledge of benzodiazepines, and their attitudes about cessation.
“ Our study found that the initiation of benzodiazepine use was often at a time of stress for the patient,” she says.“ Long-term use was not intended, and patients conveyed poor awareness of the side-effects and addictive potential of benzodiazepines.”
Aged Care Insite sits down with Williams to discuss what’ s needed to reduce overuse of benzodiazepines and the things people should know when they stop taking the medications.
ACI: When are benzodiazepines prescribed and how are they used among older Australians? FW: Benzodiazepines can be used for a number of things.
Sometimes they can be used for short-term treatment of anxiety. The ones we looked at were benzodiazepines that are taken at night and used as a form of sleeping tablet.
Among those surveyed, you found that some elderly patients were using benzodiazepines for more than 20 years. Was that common and what concerns do you have if people use the drugs for prolonged periods? The people we interviewed took them for varying amounts of time, but some certainly have been taking them for up to 20 years. You see that over the years in general practice; it’ s not uncommon that you would see people that had been taking them for considerable time periods.
As far as concerns, it has been shown that they become much less effective after they’ ve been used for two to four weeks. Often they’ re not having any benefit to the person taking them for so long. Whenever patients take them, whether it’ s short-term or long-term, they risk side-effects, particularly the elderly. Other studies have shown they increase risks of road-traffic accidents, falls and cognitive decline.
You found that many older patients would be willing to stop taking the drugs if counselled to do so. Why does this not happen more often? Is lack of communication or public awareness of benzodiazepine use to blame? Probably a little bit of both. [ Based on our interviews ], often patients weren’ t aware of the potential side-effects and the fact that benzodiazepines were addictive.
We titled the paper A Circle of Silence [ because ] it seemed that no one was talking about it. When patients presented for a repeat prescription, they felt that their doctors approved of them taking [ benzodiazepines ] because they weren’ t challenged when they asked for the prescription.
From the doctors’ side of things, other studies have shown that they can perceive that patients will be resistant to not taking the
24 agedcareinsite. com. au