title: Use of the EMPOWER brochure to deprescribe sedative-hypnotic drugs in older adults with mild cognitive impairment.
abstract: Evidence-based mailed educational brochures about the harms of sedative-hypnotic use lead to discontinuation of chronic benzodiazepine use in older adults. It remains unknown whether patients with mild cognitive impairment (MCI) are able to understand the information in the EMPOWER brochures, and whether they achieve similar rates of benzodiazepine discontinuation.
  
  
  
  Post-hoc analysis of the EMPOWER randomized, double-blind, wait-list controlled trial that assessed the effect of a direct-to-consumer educational intervention on benzodiazepine discontinuation. 303 community-dwelling chronic users of benzodiazepine medication aged 65-95 years were recruited from general community pharmacies in the original trial, 261 (86%) of which completed the trial extension phase. All participants of the control arm received the EMPOWER brochure during the trial extension. Normal cognition (n = 139) or MCI (n = 122) was determined during baseline cognitive testing using the Montreal Cognitive Assessment questionnaire. Changes in knowledge pre- and post-intervention were assessed with a knowledge questionnaire and changes in beliefs were calculated using the Beliefs about Medicines Questionnaire. Logistic regression was used to compare knowledge gained, change in beliefs and benzodiazepine cessation rates between participants with and without MCI.
  
  
  
  Complete discontinuation of benzodiazepines was achieved in 39 (32.0% [24.4,40.7]) participants with MCI and in 53 (38.1% [30.5,46.4]) with normal cognition (adjusted OR 0.79, 95% CI [0.45-1.38]). Compared to individuals with normal cognition, MCI had no effect on the acquisition of new knowledge, change in beliefs about benzodiazepines or elicitation of cognitive dissonance.
  
  
  
  The EMPOWER brochure is effective for reducing benzodiazepines in community-dwelling older adults with mild cognitive impairment.
  
  
  
  Our ClinicalTrials.gov identifier is NCT01148186 , June 21st2010.
authors.affiliation: Institut Universitaire de Gériatrie de Montréal, Université de Montréal, 4545 Queen Mary Road, Montreal, QC, H3W 1W5, Canada. philippe.martin@umontreal.ca.|Faculty of Pharmacy, University of Montreal, Quebec, Canada. philippe.martin@umontreal.ca.
authors.forename: Philippe
authors.identifier: 0000-0003-0053-6617
authors.initials: P
authors.lastname: Martin
authors.affiliation: Institut Universitaire de Gériatrie de Montréal, Université de Montréal, 4545 Queen Mary Road, Montreal, QC, H3W 1W5, Canada.|Faculty of Pharmacy, University of Montreal, Quebec, Canada.|Faculty of Medicine, University of Montreal, Quebec, Canada.
authors.forename: Cara
authors.initials: C
authors.lastname: Tannenbaum
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001569:Benzodiazepines / Q000008:administration & dosage* / Q000009:adverse effects; D060825:Cognitive Dysfunction / Q000188:drug therapy* / Q000523:psychology; D004311:Double-Blind Method; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D010174:Pamphlets; D010353:Patient Education as Topic / Q000379:methods*; D014850:Waiting Lists
chemical_list: D006993:Hypnotics and Sedatives; D001569:Benzodiazepines
keywords: Benzodiazepines; Deprescribing; Discontinuation; Inappropriate prescription; Patient education