title: Feasibility of discontinuing chronic benzodiazepine use in nursing home residents: a pilot study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Heymans Institute of Pharmacology, Ghent University, De Pintelaan 185 (1 Block B), 9000, Ghent, Belgium, jolyce.bourgeois@ugent.be.
authors.forename: Jolyce
authors.initials: J
authors.lastname: Bourgeois
authors.forename: Monique M
authors.initials: MM
authors.lastname: Elseviers
authors.forename: Luc
authors.initials: L
authors.lastname: Van Bortel
authors.forename: Mirko
authors.initials: M
authors.lastname: Petrovic
authors.forename: Robert H
authors.initials: RH
authors.lastname: Vander Stichele
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001569:Benzodiazepines / Q000008:administration & dosage* / Q000627:therapeutic use; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D009735:Nursing Homes; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy*; D013375:Substance Withdrawal Syndrome / Q000453:epidemiology; D011795:Surveys and Questionnaires
chemical_list: D006993:Hypnotics and Sedatives; D001569:Benzodiazepines
references.citation: Br J Gen Pract. 2006 Dec;56(533):964-7
references.pmid: 17132386
references.citation: N Engl J Med. 1992 Jul 16;327(3):168-73
references.pmid: 1608408
references.citation: Int J Geriatr Psychiatry. 1999 Sep;14(9):754-60
references.pmid: 10479747
references.citation: BMJ. 2005 Nov 19;331(7526):1169
references.pmid: 16284208
references.citation: Clin Interv Aging. 2014 Jan 22;9:201-7
references.pmid: 24489461
references.citation: Pharmacoepidemiol Drug Saf. 2010 Oct;19(10):1041-8
references.pmid: 20564427
references.citation: Br J Gen Pract. 2010 May;60(574):e180-200
references.pmid: 20423574
references.citation: CNS Drugs. 2009;23(1):19-34
references.pmid: 19062773
references.citation: Ann Pharmacother. 1992 Apr;26(4):539-46
references.pmid: 1576393
references.citation: Ir J Med Sci. 1989 Dec;158(12):294-9
references.pmid: 2576423
references.citation: CMAJ. 2007 May 8;176(10):1449-54
references.pmid: 17485699
references.citation: Br J Addict. 1987 Jun;82(6):665-71
references.pmid: 2886145
references.citation: Int J Geriatr Psychiatry. 2007 Sep;22(9):837-42
references.pmid: 17199236
references.citation: BMJ. 2011 Mar 11;342:d1199
references.pmid: 21398351
references.citation: Can Fam Physician. 2007 Jul;53(7):1200-1
references.pmid: 17872818
references.citation: Addiction. 2009 Jan;104(1):13-24
references.pmid: 18983627
references.citation: J Am Geriatr Soc. 2012 Jul;60(7):1292-7
references.pmid: 22725849
references.citation: Soc Sci Med. 2006 Mar;62(5):1237-49
references.pmid: 16143440
references.citation: Psychiatry Res. 1989 May;28(2):193-213
references.pmid: 2748771
references.citation: Ind Health. 2008 Dec;46(6):601-6
references.pmid: 19088412
references.citation: Eur J Clin Pharmacol. 2002 Jan;57(11):759-64
references.pmid: 11868796
references.citation: Eur J Clin Pharmacol. 2011 Jan;67(1):105-6
references.pmid: 20842354
references.citation: Pharmacoepidemiol Drug Saf. 2013 Jul;22(7):728-34
references.pmid: 23494811
references.citation: JAMA. 1991 Nov 6;266(17):2392-7
references.pmid: 1681121
references.citation: Aging Ment Health. 2008 Mar;12(2):244-8
references.pmid: 18389405
references.citation: BMC Fam Pract. 2011 Apr 20;12:23
references.pmid: 21507257
references.citation: Aust N Z J Med. 1993 Aug;23(4):343-7
references.pmid: 7902083
references.citation: J Gen Intern Med. 2007 Mar;22(3):303-7
references.pmid: 17356959
references.citation: Arch Gen Psychiatry. 1990 Oct;47(10):899-907
references.pmid: 2222129
references.citation: Ann Med. 2001 Jul;33(5):337-43
references.pmid: 11491192
references.citation: Drugs Aging. 2005;22(9):793-800
references.pmid: 16156683
references.citation: Health Econ. 1996 Mar-Apr;5(2):141-54
references.pmid: 8733106
references.citation: J Am Geriatr Soc. 2009 May;57(5):761-89
references.pmid: 19484833
references.citation: Br J Psychiatry. 2014 Feb;204(2):98-107
references.pmid: 24493654
references.citation: J Am Med Dir Assoc. 2013 Jan;14(1):29-33
references.pmid: 23098415
references.citation: J Psychiatr Res. 1982-1983;17(1):37-49
references.pmid: 7183759
references.citation: Int Clin Psychopharmacol. 1999 Sep;14(5):287-303
references.pmid: 10529072
references.citation: Psychol Med. 1998 May;28(3):721-9
references.pmid: 9626728
references.citation: J Affect Disord. 1990 May;19(1):53-61
references.pmid: 1971833
references.citation: Int J Geriatr Psychiatry. 2005 Aug;20(8):712-21
references.pmid: 16035123
references.citation: Drugs Aging. 2010 Jun 1;27(6):435-49
references.pmid: 20524704
references.citation: Age Ageing. 2010 May;39(3):313-9
references.pmid: 20089547
references.citation: Eur J Clin Pharmacol. 1997;51(5):355-8
references.pmid: 9049574
references.citation: Med Care. 1976 May;14(5 Suppl):116-8
references.pmid: 132585
references.citation: Int J Geriatr Psychiatry. 2010 Dec;25(12):1259-65
references.pmid: 20054834
references.citation: Eur J Gen Pract. 2008;14(1):37-9
references.pmid: 18464172
references.citation: Drugs. 1994 Jul;48(1):25-40
references.pmid: 7525193
references.citation: Soc Sci Med. 2003 Mar;56(6):1345-54
references.pmid: 12600370
references.citation: Sleep Med. 2013 Jul;14(7):614-21
references.pmid: 23692988
references.citation: Aging Ment Health. 2004 May;8(3):242-8
references.pmid: 15203405
references.citation: Psychol Med. 2003 Oct;33(7):1223-37
references.pmid: 14580077
references.citation: Br J Psychiatry. 2006 Sep;189:213-20
references.pmid: 16946355
references.citation: Med Care. 2011 Jan;49(1):24-36
references.pmid: 20966784