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Feasibility of discontinuing chronic benzodiazepine use in nursing home residents: a pilot study

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Abstract
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.
Keywords
Nursing homes, Benzodiazepine, Sleep problems, Discontinuation, GERIATRIC DEPRESSION SCALE, QUALITY-OF-LIFE, MEDICARE PART D, OLDER-PEOPLE, SLEEP QUALITY, GENERAL-PRACTITIONERS, DERIVATIVE HYPNOTICS, GRADUAL WITHDRAWAL, RANDOMIZED-TRIAL, PRIMARY-CARE

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MLA
Bourgeois, Jolyce, et al. “Feasibility of Discontinuing Chronic Benzodiazepine Use in Nursing Home Residents: A Pilot Study.” EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY, vol. 70, no. 10, 2014, pp. 1251–60, doi:10.1007/s00228-014-1725-7.
APA
Bourgeois, J., Elseviers, M., Van Bortel, L., Petrovic, M., & Vander Stichele, R. (2014). Feasibility of discontinuing chronic benzodiazepine use in nursing home residents: a pilot study. EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY, 70(10), 1251–1260. https://doi.org/10.1007/s00228-014-1725-7
Chicago author-date
Bourgeois, Jolyce, Monique Elseviers, Lucas Van Bortel, Mirko Petrovic, and Robert Vander Stichele. 2014. “Feasibility of Discontinuing Chronic Benzodiazepine Use in Nursing Home Residents: A Pilot Study.” EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY 70 (10): 1251–60. https://doi.org/10.1007/s00228-014-1725-7.
Chicago author-date (all authors)
Bourgeois, Jolyce, Monique Elseviers, Lucas Van Bortel, Mirko Petrovic, and Robert Vander Stichele. 2014. “Feasibility of Discontinuing Chronic Benzodiazepine Use in Nursing Home Residents: A Pilot Study.” EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY 70 (10): 1251–1260. doi:10.1007/s00228-014-1725-7.
Vancouver
1.
Bourgeois J, Elseviers M, Van Bortel L, Petrovic M, Vander Stichele R. Feasibility of discontinuing chronic benzodiazepine use in nursing home residents: a pilot study. EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY. 2014;70(10):1251–60.
IEEE
[1]
J. Bourgeois, M. Elseviers, L. Van Bortel, M. Petrovic, and R. Vander Stichele, “Feasibility of discontinuing chronic benzodiazepine use in nursing home residents: a pilot study,” EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY, vol. 70, no. 10, pp. 1251–1260, 2014.
@article{5671616,
  abstract     = {{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.}},
  author       = {{Bourgeois, Jolyce and Elseviers, Monique and Van Bortel, Lucas and Petrovic, Mirko and Vander Stichele, Robert}},
  issn         = {{0031-6970}},
  journal      = {{EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY}},
  keywords     = {{Nursing homes,Benzodiazepine,Sleep problems,Discontinuation,GERIATRIC DEPRESSION SCALE,QUALITY-OF-LIFE,MEDICARE PART D,OLDER-PEOPLE,SLEEP QUALITY,GENERAL-PRACTITIONERS,DERIVATIVE HYPNOTICS,GRADUAL WITHDRAWAL,RANDOMIZED-TRIAL,PRIMARY-CARE}},
  language     = {{eng}},
  number       = {{10}},
  pages        = {{1251--1260}},
  title        = {{Feasibility of discontinuing chronic benzodiazepine use in nursing home residents: a pilot study}},
  url          = {{http://doi.org/10.1007/s00228-014-1725-7}},
  volume       = {{70}},
  year         = {{2014}},
}

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