Evaluation of sleep inducing medications as a contributor to adverse events in the elderly


Department of Pharmacy

Presentation Notes

Presented at 2013 Aurora Scientific Day, Milwaukee, WI


Background/significance: Benzodiazepines, first generation antihistamines, sedative hypnotics, and tricyclic antidepressants are often used for inducing sleep. Patients 65 years and older are at an increased risk of falls, delirium, cognitive decline, and functional decline, and in some instances, mortality when receiving these medications. The FDA recommends reducing zolpidem doses as blood levels may be high enough the morning after use to impair activities requiring alertness. Alternative therapies may be used as substitutes for medications in promoting sleep in the elderly.

Purpose: The study’s purpose was to develop a behavioral intervention protocol that reduced the use of sleep medications in the elderly, thereby increasing patient safety and decreasing related adverse events.

Methods: Retrospective fall and medication administration data was examined for inpatients from August 2011 through December 2012. The incidence of delirium in hospitalized elderly patients was also examined during this timeframe. An alternative sleep protocol utilizing nonpharmacologic sleep alternatives was created and implemented on the ACE floor with the help of a multidisciplinary team.

Results:Thirty patients were eligible for study inclusion. Seven patients (23.33%) used a target medication before admission and 27 patients (90%) were prescribed a target medication during hospitalization. Twenty-six patients (86.67%) were placed on the alternative sleep protocol and two patients successfully used these alternative methods. Four patients (13.33%) received at least one dose of zolpidem after placement on the alternative sleep protocol. An average of 30.67 doses of zolpidem were prescribed and administered to patients 65 years and older monthly at baseline compared to 8.67 doses during the study. The average monthly falls in patients 65 years and older receiving a target medication at baseline was 0.35 and during the study was 0.67. At baseline, the monthly average delirium incidence in patients 65 years and older was 15.06% and the monthly average incidence of functional decline in these patients was 15.18%. Study period delirium and functional decline data continue to be collected.

Conclusion: While current data does not support the use of nonpharmacologic sleep alternatives to reduce falls, delirium, or functional decline, the study may have been underpowered to detect a difference. Prescribing and administration of sleep induction agents declined significantly compared to baseline.

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