Long term benzodiazepine use for insomnia in patients over the age of 60: discordance of patient and physician perceptions.
BACKGROUND
The aim of this study was to determine and compare patients' and physicians' perceptions of benefits and risks of long term benzodiazepine use for insomnia in the elderly.


METHODS
A cross-sectional study (written survey) was conducted in an academic primary care group practice in Toronto, Canada. The participants were 93 patients over 60 years of age using a benzodiazepine for insomnia and 25 physicians comprising sleep specialists, family physicians, and family medicine residents. The main outcome measure was perception of benefit and risk scores calculated from the mean of responses (on a Likert scale of 1 to 5) to various items on the survey.


RESULTS
The mean perception of benefit score was significantly higher in patients than physicians (3.85 vs. 2.84, p < 0.001, 95% CI 0.69, 1.32). The mean perception of risk score was significantly lower in patients than physicians (2.21 vs. 3.63, p < 0.001, 95% CI 1.07, 1.77).


CONCLUSIONS
There is a significant discordance between older patients and their physicians regarding the perceptions of benefits and risks of using benzodiazepines for insomnia on a long term basis. The challenge is to openly discuss these perceptions in the context of the available evidence to make collaborative and informed decisions.
Mah
Leevin
L
Family Medicine Residency Program, Department of Family and Community Medicine Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Ontario, Canada. leevin.mah@utoronto.ca
Upshur
Ross E G
RE
D000368:Aged; D001291:Attitude of Health Personnel; D001569:Benzodiazepines / Q000145:classification / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D004363:Drug Utilization; D005260:Female; D006123:Group Practice / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011159:Population Surveillance; D011320:Primary Health Care / Q000706:statistics & numerical data*; D018570:Risk Assessment; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy*
D001569:Benzodiazepines